Hemoglobin A1c in combination with fasting plasma glucose trumps fasting plasma glucose alone as predictive indicators for diabetes mellitus: an ambidirectional cohort study of Thai people with impaired fasting glucose

Abstract

IntroductionThis ambidirectional cohort study aimed to assess the performance of combining hemoglobin A1c (HbA1c) to fasting plasma glucose (FPG) for estimation of progression rate to diabetes mellitus (DM) and to explore the risk factors of DM in patients with impaired fasting glucose (IFG).Research design and methodsPatients with IFG were eligible for this study. IFG was defined as FPG of 100–125 mg/dL. Progression rates to DM were estimated using Kaplan-Meier analysis. Risk factors of DM were explored by Cox regression analysis.Results3011 patients were enrolled with median follow-up time of 8 years (range: 6 months–29 years). Progression rates to DM in patients with FPG 100–109 mg/dL and 110–125 mg/dL were 2.64 and 4.79 per 100 person-years. After adjusting covariables, compared with patients with FPG 100–109 mg/dL plus normal HbA1c (<5.7%), hazard ratios (95% CI) of patients with FPG 110–125 plus normal HbA1c, FBG 100–109 plus abnormal HbA1c (5.7%–6.49%), and FPG 110–125 plus abnormal HbA1c were 5.89 (2.37 to 14.63), 16.30 (8.59 to 30.92), and 33.84 (16.41 to 69.78), respectively. Body mass index ≥27.5 kg/m2, serum triglyceride level ≥150 mg/dL, family history of DM, and low level of high-density lipoprotein-cholesterol were independently associated with risk of DM in patients with IFG.ConclusionsPatients with both IFG and abnormal HbA1c had higher risk of DM than patients with IFG alone. Therefore, performing HbA1c in combination with FPG helps to identify subgroups of people with IFG at highest risk of DM. These patients should have the highest priority in diabetes prevention programs, especially in countries with low and limited resources.

Efficacy of Time-Restricted Eating and Behavioral Economic Intervention in Reducing Fasting Plasma Glucose, HbA1c, and Cardiometabolic Risk Factors in Patients with Impaired Fasting Glucose: A Randomized Controlled Trial

“…A superiority trial approach utilizing a one-way analysis of variance method was applied for estimating the sample size. The baseline mean and standard deviation (SD) of FPG in the prediabetes cohort were 105 and 9 mg/dL, respectively [26]. We anticipated that receiving TRE plus BE, and TRE alone would lead to a reduction in the FPG of approximately 7% and 5%, respectively, compared to the control group.…”

Fasting plasma glucose and HbA1c levels predict the risk of type 2 diabetes and diabetic retinopathy in a Thai high-risk population with prediabetes

“…In contrast, the previously mentioned Thai studies only provided information on DM incidence in the low-to moderate-risk population with prediabetes. ( Thamakaison et al, 2021 ; Wutthisathapornchai A 2021 ) In addition, the analyses drew on an extensive study sample.…”

A Prediction Model of the Incidence of Type 2 Diabetes in Individuals with Abdominal Obesity: Insights from the General Population

“…An ambidirectional cohort study indicated that patients with both high FPG and abnormal HbA1c are at a higher risk of developing T2DM, while HbA1c in combination with FPG may help distinguish the subgroups with the highest risk of diabetes in people with impaired fasting glucose. 9,40 Elevated FPG levels are associated with lower insulin response and sensitivity and are related to an increased incidence of T2DM. 41 To the best of our knowledge, this is the first nomogram to predict incident T2DM in obese patients with abdominal obesity, using a standardized lifestyle factor questionnaire.…”