HbA1c and cardiovascular risk score identify people who may benefit from preventive interventions: a 7 year follow-up of a high-risk screening programme for diabetes in primary care (ADDITION), Denmark

Lauritzen, Torsten; Sandbæk, Annelli; Skriver, Mette Vinther; Borch‐Johnsen, Knut

doi:10.1007/s00125-011-2077-9

Cited by 29 publications

(29 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our data are also in agreement with findings from the EPIC-Norfolk cohort [9] that HbA 1c could have a value in CVE prediction in non-diabetic men (NRI 2.2% vs 3.4%, respectively) but not women (NRI −0.2% vs −2.2%, respectively). Furthermore, the results for men are in line with findings from the ADDITION study [32] that combined a SCORE result of ≥5 with an HbA 1c value ≥6.0% and identified 96.7% of those who would benefit from an intervention compared with 91.7% if the screening was performed with only those with a SCORE result ≥5. This is one possibility of how to implement the additional predictive value of HbA 1c for CVE for men into routine screening programmes with the SCORE.…”

Section: Risk For Incident Cardiovascular Eventssupporting

confidence: 83%

Fasting plasma glucose and HbA1c in cardiovascular risk prediction: a sex-specific comparison in individuals without diabetes mellitus

et al. 2012

View full text Add to dashboard Cite

Section: Risk For Incident Cardiovascular Eventssupporting

confidence: 83%

Fasting plasma glucose and HbA1c in cardiovascular risk prediction: a sex-specific comparison in individuals without diabetes mellitus

et al. 2012

View full text Add to dashboard Cite

“…This finding confirms that prediction of macrovascular complications should only play a marginal role with regard to HbA 1c thresholds for diabetes. The idea that the HbA 1c should be combined with other risk factors in preventive interventions was demonstrated in the Anglo-Danish-Dutch study of Intensive Treatment in People with Screen Detected Diabetes in Primary Care (ADDITION) study 39. Subjects who might benefit from interventions were defined by either screen detected diabetes or by excess mortality.…”

Section: How Well Does the Recommended Hba1c Threshold Of 65% Fulfilmentioning

confidence: 99%

HbA1c for diagnosis of type 2 diabetes. Is there an optimal cut point to assess high risk of diabetes complications, and how well does the 6.5% cutoff perform?

Kowall¹,

Rathmann²

2013

DMSO

View full text Add to dashboard Cite

Glycated hemoglobin (HbA1c) has recently been recommended for the diagnosis of type 2 diabetes mellitus (T2DM) by leading diabetes organizations and by the World Health Organization. The most important reason to define T2DM is to identify subjects with high risk of diabetes complications who may benefit from treatment. This review addresses two questions: 1) to assess from existing studies whether there is an optimal HbA1c threshold to predict diabetes complications and 2) to assess how well the recommended 6.5% cutoff of HbA1c predicts diabetes complications. HbA1c cutoffs derived from predominantly cross-sectional studies on retinopathy differ widely from 5.2%–7.8%, and among other reasons, this is due to the heterogeneity of statistical methods and differences in the definition of retinopathy. From the few studies on other microvascular complications, HbA1c thresholds could not be identified. HbA1c cutoffs make less sense for the prediction of cardiovascular events (CVEs) because CVE risks depend on various strong risk factors (eg, hypertension, smoking); subjects with low HbA1c levels but high values of CVE risk factors were shown to be at higher CVE risk than subjects with high HbA1c levels and low values of CVE risk factors. However, the recommended 6.5% threshold distinguishes well between subjects with and subjects without retinopathy, and this distinction is particularly strong in severe retinopathy. Thus, in existing studies, the prevalence of any retinopathy was 2.5 to 4.5 times as high in persons with HbA1c-defined T2DM as in subjects with HbA1c <6.5%. To conclude, from existing studies, a consistent optimal HbA1c threshold for diabetes complications cannot be derived, and the recommended 6.5% threshold has mainly been brought about by convention rather than by having a consistent empirical basis. Nevertheless, the 6.5% threshold is suitable to detect subjects with prevalent retinopathy, which is the most diabetes specific complication. However, most of the studies on associations between HbA1c and microvascular diabetes complications are cross-sectional, and there is a need for longitudinal studies.

show abstract

“…It has been shown that an important proportion of individuals with IFG and/or IGT do not have elevated HbA 1c [7,8]. Few data so far exist that evaluated the comparability of the new HbA 1c -defined pre-diabetes definition with IFG and IGT.…”

Section: Introductionmentioning

confidence: 98%

Prognostic value of haemoglobin A1c and fasting plasma glucose for incident diabetes and implications for screening

et al. 2011

View full text Add to dashboard Cite

The aim of this analysis is to compare screening strategies with haemoglobin A(1c) (HbA(1c)), fasting plasma glucose (FPG) or combined measures in the identification of individuals at high risk for diabetes. Applying American Diabetes Association thresholds for FPG and HbA(1c) screening, 6,803 subjects free of diabetes were classified as non-diabetic, pre-diabetic and possibly diabetic by FPG (<100, 100-125 and >125 mg/dl) and HbA(1c) (<5.7, 5.7-6.4 and >6.4%). Hazard ratios, sensitivity and specificity were estimated for individuals with pre-diabetes with respect to incident diabetes in the following 5 years. Areas under the receiver operating characteristic curves (AUC) were estimated for levels of FPG ≤ 125 mg/dl and HbA(1c) ≤ 6.4% in diabetes prediction. Although FPG and HbA(1c) screenings poorly agreed in classifying individuals as pre-diabetic, hazard ratios [95% confidence interval] for incident diabetes were similarly increased in univariate models in the two pre-diabetic groups: FPG 100-125 mg/dl, 4.72 [3.69; 6.05]; HbA(1c) 5.7-6.4%, 3.97 [3.05; 5.23]. HbA(1c) and FPG had comparable AUCs (FPG, 0.732; HbA(1c), 0.725) and consequently similar 5-year sensitivities and specificities for their pre-diabetes definitions (when the lower cut-off for HbA(1c)-defined pre-diabetes was increased to a level between 5.8 and 5.9%). Combining HbA(1c) and FPG increased the AUC to 0.778, and a further increase to 0.817 was seen with additional inclusion of conventional risk factors. FPG and HbA(1c) have comparable (yet insufficient) abilities in identifying individuals at high risk for diabetes. Effectiveness of a diabetes screening program could be improved by a risk score including FPG and HbA(1c).

show abstract

HbA1c and cardiovascular risk score identify people who may benefit from preventive interventions: a 7 year follow-up of a high-risk screening programme for diabetes in primary care (ADDITION), Denmark

Cited by 29 publications

References 22 publications

Fasting plasma glucose and HbA1c in cardiovascular risk prediction: a sex-specific comparison in individuals without diabetes mellitus

Fasting plasma glucose and HbA1c in cardiovascular risk prediction: a sex-specific comparison in individuals without diabetes mellitus

HbA1c for diagnosis of type 2 diabetes. Is there an optimal cut point to assess high risk of diabetes complications, and how well does the 6.5% cutoff perform?

Prognostic value of haemoglobin A1c and fasting plasma glucose for incident diabetes and implications for screening

Contact Info

Product

Resources

About