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

Kumaravel, B., Bachmann, M.O., Murray, N., Dhatariya, K., Fenech, M., John, W.G., Scarpello, Tracey and Sampson, M.J. (2012) Use of haemoglobin A1c to detect impaired fasting glucose or Type 2 diabetes in a United Kingdom community based population. Diabetes Research and Clinical Practice, 96 (2). pp. 211-216.

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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/m ), 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 5.6-6.9mmol/l, or 6.1-6.9mmol/l), and T2DM (FPG=7.0mmol/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 = 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 'pre-diabetes' 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 'pre-diabetes' 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 'pre-diabetes' based on fasting glucose data. © 2011 Elsevier Ireland Ltd.

Item Type: Article
Additional Information: Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
Uncontrolled Keywords: humans,aged,middle aged,fasting,male,great britain,female,blood glucose
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
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Depositing User: Users 2731 not found.
Date Deposited: 12 Feb 2012 23:07
Last Modified: 21 Apr 2020 16:23
DOI: 10.1016/j.diabres.2011.12.004

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