HbA1c may not be a sensitive determinant of diabetic status in the elderly

The cutoffs and performance of glycated hemoglobin for diagnosing diabetes and prediabetes in a young and middle-aged population and in an elderly population

“…Similar results were observed when HbA1c was used to identify prediabetes. The finding of the poor performance of HbA1c as a diagnostic tool was in line with other studies [20,27,31,33]. However, we also observed that the sensitivities or specificities for diagnosing diabetes and prediabetes increased when combining HbA1c and fasting plasma glucose, which was consistent with previous studies [34].…”

“…Interestingly, the age-specific HbA1c criteria were higher in Yang's study than in the present study in both the young and middle-aged population (6.1% (43 mmol/mol) to 6.4% (46 mmol/mol) vs. 5.7% (39 mmol/mol)) and the elderly population (6.5% (48 mmol/mol) to 6.4% (46 mmol/mol) vs. 5.9% (41 mmol/ mol)). The differences of HbA1c cutoffs among different populations in the same age range were also observed in other previous studies [20,27,31], which could be partly explained by variations in HbA1c levels derived from racial disparities, regional discrepancies, inconsistencies of blood sample collection time and HbA1c tests among different laboratories, as well as differences in the prevalence of hemoglobinopathies [8,14,25].…”

“…Although the role of HbA1c as a diagnostic indicator was recognized, more longitudinal epidemiological studies have reported that demographic and ethnic factors may contribute to complications in using HbA1c for the diagnosis of diabetes, and the optimal diagnostic HbA1c cutoff of is debated and varies due to genetic and biological variations [16][17][18]. Moreover, previous studies demonstrated that there are normal age-related increases in HbA1c [19,20], suggesting possible differences in HbA1c cutoffs in populations of different ages. Recently, Yang et al [21] also reported the effect of age on HbA1c for diagnosing diabetes, but most of the subjects in his study were patients with diabetes and the performance of age-specific HbA1c criteria was not evaluated.…”

A New Strategy for Early Diagnosis of Type 2 Diabetes by Standard-Free, Label-Free LC-MS/MS Quantification of Glycated Peptides

“…In an effort to identify novel biomarkers for diabetes, research has shown that neither plasma glucose nor glycated hemoglobin (HbA 1c ) levels are able to be used in the early detection of diabetes (6–9). Plasma glucose is easily affected by patients’ lifestyle (e.g., food intake and body condition).…”

Glycemic control in the clinical management of diabetic patients

“…The proportions of undiagnosed diabetes were 3.1% and 2.7%, respectively, using FPG ≥ 126 mg/dL and HbA 1c ≥ 6.5% (48 mmol/mol) [ 57 ]. Another study conducted on Asian patients using ROC curve analysis found that an HbA 1c test result of 6.2% (44 mmol/mol) was the best cut-off for diagnosing diabetes, but the sensitivity and specificity of the area under the ROC curve deteriorated as the age groups increased [ 58 ]. In addition, there are several practical implications to consider when HbA 1c is adopted as the preferred tool for diagnosing diabetes, as already explained [ 8 ].…”