Fasting Plasma Glucose and Hemoglobin A1c in Identifying and Predicting Diabetes

Wang, Wenyu; Lee, Elisa T.; Howard, Barbara V.; Fabsitz, Richard R.; Devereux, Richard B.; Welty, Thomas K.

doi:10.2337/dc10-1680

Cited by 44 publications

(44 citation statements)

References 25 publications

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“…Results of the EPIC-Potsdam Study also suggested that risk reclassification was improved by adding FPG (IDI 0.0553) or HbA 1c (IDI 0.0974) values using the prediction model by the German Diabetes Risk Score as a reference [14]. Recent prospective studies have examined the utility of introducing HbA 1c testing for predicting diabetes [15,16,[23][24][25][26][27], and some reports have described the development of models to predict future diabetes using blood variables including FPG and HbA 1c [15,25,29]. More recently and concomitantly with the preparation of this manuscript, a risk score that concurrently included measurements of FPG, HbA 1c and other biochemical markers was reported in a Korean population [40].…”

Section: Discussionmentioning

confidence: 99%

“…Introducing HbA 1c into a prediction model has been suggested to be effective in screening for future diabetes [14][15][16][22][23][24][25][26][27][28], and a few models to predict the development of diabetes have recently been developed that concurrently include measurements of FPG, HbA 1c and other blood markers [15,25,29]. After revising the diagnostic criteria for type 2 diabetes by introducing HbA 1c in 2010 [30], the ADA published guidelines and recommendations for diagnosing diabetes based on published data or derived from expert consensus [31].…”

Section: Introductionmentioning

confidence: 99%

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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%

Section: Introductionmentioning

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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“…Internationally, research on the sensitivity and specificity of HbA 1c and FPG testing for undiagnosed diabetes has been inconsistent (22)(23)(24)(25)34,35). Further, in the few studies to date that have directly compared prediabetes prevalence according to FPG and HbA 1c criteria, considerable differences between estimates have been noted, largely by finding HbA 1c (5.7-6.4% [39-48 mmol/mol]) to be a less sensitive criterion than FPG (5.6-6.9 mmol/L [or equivalently 100-125 mg/dL]).…”

Section: Discussionmentioning

confidence: 99%

“…Given recent additions to diagnostic guidelines (16) to include hemoglobin A 1c (HbA 1c ) levels, assessing the hidden burden of undiagnosed diabetes has again become particularly important. Where the measurement of FPG level is relatively simple and inexpensive to perform, HbA 1c measurement is a more convenient diagnostic technique that does not require the patient to fast and displays less day-to-day variability (14,(17)(18)(19)(20)(21)(22)(23)(24)(25). HbA 1c measurement is also attractive for opportunistic screening as it can be performed at any time of the day without prior fasting.…”

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confidence: 99%

Prevalence of Prediabetes and Undiagnosed Diabetes in Canada (2007–2011) According to Fasting Plasma Glucose and HbA1c Screening Criteria

et al. 2015

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OBJECTIVETo provide the first population-based estimates of prediabetes and undiagnosed type 2 diabetes prevalence in Canada. RESEARCH DESIGN AND METHODSWe combined two fasting subsamples of the Canadian Health Measures Survey, which were restricted to nonpregnant adults ‡20 years of age (N = 3,494). Undiagnosed diabetes was defined as not having self-reported type 2 diabetes but having blood glucose measures that met Canadian guidelines (i.e., fasting plasma glucose [FPG] level of ‡7.0 mmol/L or hemoglobin A 1c [HbA 1c ] level of ‡6.5% [ ‡48 mmol/mol]). Prediabetes was defined as an FPG level of ‡6.1 and <7.0 mmol/L or an HbA 1c level of ‡6.0% and <6.5% ( ‡42 and <48 mmol/mol). All estimates were weighted using survey sampling weights. CIs were calculated with the bootstrap method. RESULTSAccording to FPG levels, the prevalence of undiagnosed type 2 diabetes in Canadian adults was 1.13% (95% CI 0.79, 1.62), contributing to ∼20% of total type 2 diabetes prevalence (5.62 [95% CI 4.52, 6.95]). Compared with FPG levels, the undiagnosed prevalence was greater using HbA 1c level as a criterion (3.09% [95% CI 1.97, 4.81]), ∼41% of the total number of cases of diabetes (7.55 [95% CI 5.98,9.49]). The HbA 1c -only criterion resulted in a threefold increase in prediabetes prevalence overall and a sixfold increase among females (FPG 2.22%, HbA 1c 13.31%). Screening based on FPG only identified older undiagnosed case patients, with a mean age of 58.7 years (95% CI 59.9, 63.4). Similarly, using HbA 1c identified younger individuals with prediabetes, with reduced BMI and waist circumference compared with FPG levels. CONCLUSIONSIn this first study of a nationally representative sample with biospecimen measures, we found that the prevalence of undiagnosed type 2 diabetes and prediabetes was significantly higher using HbA 1c levels compared with FPG levels. Further evaluation is needed to fully assess the impact of using the HbA 1c criterion.

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“…Wang and colleagues 39 describe analyses of 4549 American Indian men and women. They developed a logistic model for the risk of diabetes defined according to HbA 1c ≥ 6.5% and FPG ≥ 7.0 mmol/l.…”

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confidence: 99%

The cost-effectiveness of testing strategies for type 2 diabetes: a modelling study

Gillett

Brennan

Watson

et al. 2015

Health Technology Assessment

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BackgroundAn estimated 850,000 people have diabetes without knowing it and as many as 7 million more are at high risk of developing it. Within the NHS Health Checks programme, blood glucose testing can be undertaken using a fasting plasma glucose (FPG) or a glycated haemoglobin (HbA1c) test but the relative cost-effectiveness of these is unknown.ObjectivesTo estimate and compare the cost-effectiveness of screening for type 2 diabetes using a HbA1ctest versus a FPG test. In addition, to compare the use of a random capillary glucose (RCG) test versus a non-invasive risk score to prioritise individuals who should undertake a HbA1cor FPG test.DesignCost-effectiveness analysis using the Sheffield Type 2 Diabetes Model to model lifetime incidence of complications, costs and health benefits of screening.SettingEngland; population in the 40–74-years age range eligible for a NHS health check.Data sourcesThe Leicester Ethnic Atherosclerosis and Diabetes Risk (LEADER) data set was used to analyse prevalence and screening outcomes for a multiethnic population. Alternative prevalence rates were obtained from the literature or through personal communication.Methods(1) Modelling of screening pathways to determine the cost per case detected followed by long-term modelling of glucose progression and complications associated with hyperglycaemia; and (2) calculation of the costs and health-related quality of life arising from complications and calculation of overall cost per quality-adjusted life-year (QALY), net monetary benefit and the likelihood of cost-effectiveness.ResultsBased on the LEADER data set from a multiethnic population, the results indicate that screening using a HbA1ctest is more cost-effective than using a FPG. For National Institute for Health and Care Excellence (NICE)-recommended screening strategies, HbA1cleads to a cost saving of £12 and a QALY gain of 0.0220 per person when a risk score is used as a prescreen. With no prescreen, the cost saving is £30 with a QALY gain of 0.0224. Probabilistic sensitivity analysis indicates that the likelihood of HbA1cbeing more cost-effective than FPG is 98% and 95% with and without a risk score, respectively. One-way sensitivity analyses indicate that the results based on prevalence in the LEADER data set are insensitive to a variety of alternative assumptions. However, where a region of the country has a very different joint HbA1cand FPG distribution from the LEADER data set such that a FPG test yields a much higher prevalence of high-risk cases relative to HbA1c, FPG may be more cost-effective. The degree to which the FPG-based prevalence would have to be higher depends very much on the uncertain relative uptake rates of the two tests. Using a risk score such as the Leicester Practice Database Score (LPDS) appears to be more cost-effective than using a RCG test to identify individuals with the highest risk of diabetes who should undergo blood testing.LimitationsWe did not include rescreening because there was an absence of required relevant evidence.ConclusionsBased on the multiethnic LEADER population, among individuals currently attending NHS Health Checks, it is more cost-effective to screen for diabetes using a HbA1ctest than using a FPG test. However, in some localities, the prevalence of diabetes and high risk of diabetes may be higher for FPG relative to HbA1cthan in the LEADER cohort. In such cases, whether or not it still holds that HbA1cis likely to be more cost-effective than FPG depends on the relative uptake rates for HbA1cand FPG. Use of the LPDS appears to be more cost-effective than a RCG test for prescreening.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Fasting Plasma Glucose and Hemoglobin A1c in Identifying and Predicting Diabetes

Cited by 44 publications

References 25 publications

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)

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)

Prevalence of Prediabetes and Undiagnosed Diabetes in Canada (2007–2011) According to Fasting Plasma Glucose and HbA1c Screening Criteria

The cost-effectiveness of testing strategies for type 2 diabetes: a modelling study

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