A1C Level and Future Risk of Diabetes: A Systematic Review

Zhang, Xuanping; Gregg, Edward W.; Williamson, David F.; Barker, Lawrence; Thomas, William I.; Bullard, Kai McKeever; Imperatore, Giuseppina; Williams, Desmond E.; Albright, Ann

doi:10.2337/dc09-1939

Cited by 332 publications

(256 citation statements)

References 28 publications

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“…Since the utility of HbA 1c as a screening tool for individuals at risk of diabetes has been recognised [46,47], it is reasonable that the use of two glycaemic indicators would be considered in developing an effective screening score for risk of diabetes. Our findings suggest that a scoring system should not be limited to using data from key conventional variables, as reported in the past, but should also include HbA 1c in the development of a diabetes risk score to further improve screening for future diabetes.…”

Section: Discussionmentioning

confidence: 99%

Development of a new scoring system for predicting the 5 year incidence of type 2 diabetes in Japan: the Toranomon Hospital Health Management Center Study 6 (TOPICS 6)

et al. 2012

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Aims/hypothesis The aims of this study were to assess the clinical significance of introducing HbA 1c into a risk score for diabetes and to develop a scoring system to predict the 5 year incidence of diabetes in Japanese individuals. Methods The study included 7,654 non-diabetic individuals aged 40-75 years. Incident diabetes was defined as fasting plasma glucose (FPG) ≥7.0 mmol/l, HbA 1c ≥6.5% (48 mmol/mol) or self-reported clinician-diagnosed diabetes. We constructed a risk score using non-laboratory assessments (NLA) and evaluated improvements in risk prediction by adding elevated FPG, elevated HbA 1c or both to NLA. Results The discriminative ability of the NLA score (age, sex, family history of diabetes, current smoking and BMI) was 0.708. The difference in discrimination between the NLA + FPG and NLA + HbA 1c scores was non-significant (0.836 vs 0.837; p00.898). A risk score including family history of diabetes, smoking, obesity and both FPG and HbA 1c had the highest discrimination (0.887, 95% CI 0.871, 0.903). At an optimal cut-off point, sensitivity and specificity were high at 83.7% and 79.0%, respectively. After initial screening using NLA scores, subsequent information on either FPG or HbA 1c resulted in a net reclassification improvement of 42.7% or 52.3%, respectively (p<0.0001). When both were available, net reclassification improvement and integrated discrimination improvement were further improved at 56.7% (95% CI 47.3%, 66.1%) and 10.9% (9.7%, 12.1%), respectively.

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Section: Discussionmentioning

confidence: 99%

Development of a new scoring system for predicting the 5 year incidence of type 2 diabetes in Japan: the Toranomon Hospital Health Management Center Study 6 (TOPICS 6)

et al. 2012

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“…, those with an A1C between 5.5-6.0% had a substantially increased risk of diabetes (5-year incidence from 9 to 25%). An A1C range of 6.0-6.5% had a 5-year risk of developing diabetes between 25-50% and a relative risk 20 times higher compared with an A1C of 5.0% (12). In a community-based study of African American and nonHispanic white adults without diabetes, baseline A1C was a stronger predictor of subsequent diabetes and cardiovascular events than fasting glucose (13).…”

Section: Fasting and 2-hour Plasma Glucosementioning

confidence: 91%

“…Prevention or Delay of Type 2 Diabetes). Similar to glucose measurements, the continuum of risk is curvilinear, so as A1C rises, the diabetes risk rises disproportionately (12). Aggressive interventions and vigilant follow-up should be pursued for those considered at very high risk (e.g., those with A1C .6.0%).…”

Section: Categories Of Increased Risk For Diabetes (Prediabetes)mentioning

confidence: 99%

2. Classification and Diagnosis of Diabetes

2014

Diabetes Care

1,531

443

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“…5 Persons with an HbA 1c value of 6.0% or above had a high risk for development of clinically defined diabetes. The 5-year risk of diabetes if the baseline HbA 1c value was at least 6% ranged from 25% to 50%.…”

Section: Introductionmentioning

confidence: 99%