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. ORCID:, Murray, N. ORCID:, 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,sdg 3 - good health and well-being ,/dk/atira/pure/sustainabledevelopmentgoals/good_health_and_well_being
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: 18 Nov 2022 15:30
DOI: 10.1016/j.diabres.2011.12.004

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