Utility of hemoglobin A1c in predicting diabetes risk

Edelman, David; Olsen, Maren K.; Dudley, Tara K.; Harris, Amy; Oddone, Eugene Z.

doi:10.1111/j.1525-1497.2004.40178.x

Cited by 182 publications

(143 citation statements)

References 31 publications

(28 reference statements)

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“…This is consistent with the contention by Kahn et al that clinical definitions of the metabolic syndrome are unnecessarily restrictive, and that the particular cluster of risk factors may not be as important as the assessment and management of each of them individually (50). Not included as often in this group of risk factors is A1c, which is emerging as a significant risk factor for diabetes, cardiovascular disease and cancer (51)(52)(53)(54)(55). In addition, there are suggestions that A1c should be used as a screening tool for diabetes in Aboriginal environments (56)(57)(58) and, thus, could be used as a first step in assessing the presence of diabetes and/or metabolic syndrome.…”

Section: Original Researchsupporting

confidence: 71%

High rates of the metabolic syndrome in a First Nations Community in western Canada: prevalence and determinants in adults and children.

Kaler

Ralph-Campbell

Pohar

et al. 2006

International Journal of Circumpolar Health

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Objectives. Increasing type 2 diabetes in Aboriginal communities across North America raises concerns about metabolic syndrome in these populations. Some prevalence information for American Indians exists, but little has been available for Canada's First Nations. Study Design. We screened 60 % of the eligible population of a single First Nation in Alberta for diabetes, prediabetes, cardiovascular risk, and metabolic syndrome. Methods. NCEP/ATP III and IDF criteria were used to identify metabolic syndrome in participants aged ≥ 18; modified NCEP/ATP III criteria were used for participants aged < 18. Logistic regression identified factors associated with the metabolic syndrome. Results. 297 individuals were screened (176 adults, 84 children/adolescents, with complete data). 52.3 % of adults had metabolic syndrome using NCEP/ATP III criteria, and 50 % using IDF criteria. 40.5 % of individuals aged < 18 had the condition. Waist circumference was the most prevalent correlate. Bivariate analysis suggested that age, BMI, weight, A1c, LDL-C, ADA risk score and activity pattern were associated with metabolic syndrome. Conclusions. Our data represent the first available for Western Cree and are consistent with prevalence reported for Aboriginal populations in Ontario and Manitoba. High rates of obesity, pre-diabetes and metabolic syndrome for participants aged < 18 raise concerns about future prevalence of diabetes and cardiovascular disease.

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Section: Original Researchsupporting

confidence: 71%

High rates of the metabolic syndrome in a First Nations Community in western Canada: prevalence and determinants in adults and children.

Kaler

Ralph-Campbell

Pohar

et al. 2006

International Journal of Circumpolar Health

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“…This is despite the many advantages to using HbA 1c over other glycaemic measures such as less intraindividual variation [29], good ability to detect undiagnosed diabetes [46,47] and predict risk of developing microvascular complications both in type 1 and type 2 diabetes [9,10,48], and widespread acceptance as a common endpoint in clinical trials. Our study suggests that HbA 1c may be a useful measure for diagnosing diabetes and supports a possible cut-off point at between 6.6% and 7.0%, which is in line with current recommendations [12,13,30,47].…”

Section: Discussionmentioning

confidence: 99%

Relationship between glycated haemoglobin and microvascular complications: Is there a natural cut-off point for the diagnosis of diabetes?

et al. 2009

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Aims/hypothesis This study was designed to determine whether the relationship of glycated haemoglobin to diabetic microvascular complications shows any natural thresholds that could be useful in diagnosing diabetes. Methods We examined a population-based sample of 3,190 Malay adults aged 40-80 years in Singapore. The microvascular outcomes of interest were: (1) any retinopathy, defined from fundus photographs; (2) mild retinopathy, defined as in (1); (3) moderate retinopathy, defined as in (1); (4) chronic kidney disease, defined from estimated glomerular filtration rate; (5) micro-or macroalbuminuria, defined from urinary albumin to creatinine ratio; and (6) peripheral neuropathy, defined from neurothesiometer or monofilament sensory testing. Results Increasing HbA 1c was associated with all microvascular complications. The optimal cut-off points for detecting mild and moderate retinopathy were 6.6% (87.0% sensitivity, 77.1% specificity and area under the receiver operating characteristics [ROC] curve 0.899) and 7.0% (82.9% sensitivity, 82.3% specificity and area under ROC curve 0.904). The prevalences of mild and moderate retinopathy were <1% below the optimal cut-off points. For other complications, the association with HbA 1c was linear without evidence of a distinct threshold. Although ROC analysis for these other complications also suggested optimal cut-off points between 6.6% and 7.0%, the sensitivity at these cut-off points was considerably lower than for mild and moderate retinopathy, ranging from 31.8% to 66.5%. Conclusions/interpretation Higher levels of HbA 1c were associated with microvascular complications. Our data support use of an HbA 1c cut-off point of between 6.6 and 7.0% in diagnosing diabetes. Cut-off points in this range were best for the identification of individuals with mild and moderate retinopathy. Any retinopathy, chronic kidney disease, albuminuria and peripheral neuropathy are less well detected at these cut-off points.

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“…found that diabetes incidence was 2.5% per year for HbA1c between 5.6% and 6.0% [21]. The Expert Committee defined individuals with an HbA1c between 6.0% and 6.5% as being at high risk of diabetes [11]; subsequently, in January 2010 a new threshold of 5.7% was published in the ADA recommendations [10].…”

Section: 7% 12/01/2012mentioning

confidence: 99%

HbA1c, fasting plasma glucose and the prediction of diabetes: Inter99, AusDiab and D.E.S.I.R.

Soulimane

Simon

Shaw

et al. 2012

Diabetes Research and Clinical Practice

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Utility of hemoglobin A1c in predicting diabetes risk

Cited by 182 publications

References 31 publications

High rates of the metabolic syndrome in a First Nations Community in western Canada: prevalence and determinants in adults and children.

High rates of the metabolic syndrome in a First Nations Community in western Canada: prevalence and determinants in adults and children.

Relationship between glycated haemoglobin and microvascular complications: Is there a natural cut-off point for the diagnosis of diabetes?

HbA1c, fasting plasma glucose and the prediction of diabetes: Inter99, AusDiab and D.E.S.I.R.

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