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. 2010 Sep;33(9):2077-83.
doi: 10.2337/dc10-0262. Epub 2010 Jun 23.

Postchallenge glucose, A1C, and fasting glucose as predictors of type 2 diabetes and cardiovascular disease: a 10-year prospective cohort study

Henna Cederberg  1 , Tuula Saukkonen, Mauri Laakso, Jari Jokelainen, Pirjo Härkönen, Markku Timonen, Sirkka Keinänen-Kiukaanniemi, Ulla Rajala
Affiliations

Postchallenge glucose, A1C, and fasting glucose as predictors of type 2 diabetes and cardiovascular disease: a 10-year prospective cohort study

Henna Cederberg et al. Diabetes Care. 2010 Sep.

Abstract

Objective: A1C has been proposed as a new indicator for high risk of type 2 diabetes. The long-term predictive power and comparability of elevated A1C with the currently used high-risk indicators remain unclear. We assessed A1C, impaired glucose tolerance (IGT), and impaired fasting glucose (IFG) as predictors of type 2 diabetes and cardiovascular disease (CVD) at 10 years.

Research design and methods: This prospective population-based study of 593 inhabitants from northern Finland, born in 1935, was conducted between 1996 and 2008. An oral glucose tolerance test (OGTT) was conducted at baseline and follow-up, and A1C was determined at baseline. Those with a history of diabetes were excluded from the study. Elevated A1C was defined as 5.7-6.4%. Incident type 2 diabetes was confirmed by two OGTTs. Cardiovascular outcome was measured as incident CVD or CVD mortality. Multivariate log-binomial regression models were used to predict diabetes, CVD, and CVD mortality at 10 years. Receiver operating characteristic curves compared predictive values of A1C, IGT, and IFG.

Results: Incidence of diabetes during the follow-up was 17.1%. Two of three of the cases of newly diagnosed diabetes were predicted by a raise in >or=1 of the markers. Elevated A1C, IGT, or IFG preceded diabetes in 32.8, 40.6, and 21.9%, respectively. CVD was predicted by an intermediate and diabetic range of 2-h glucose but only by diabetic A1C levels in women.

Conclusions: A1C predicted 10-year risk of type 2 diabetes at a range of A1C 5.7-6.4% but CVD only in women at A1C >or=6.5%.

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Figures

Figure 1
Figure 1
Formation of the study population for diabetes and CVD analysis.
Figure 2
Figure 2
Venn diagram representing the percentage of elevated A1C, IGT, and IFG at baseline among participants who developed diabetes during the 10-year follow-up (n = 64). Area outside the circles indicates those with no elevated markers at baseline. Percentages in brackets indicate participants with either an isolated marker or a combination of markers. Surface area of region is proportional to the percentage.
Figure 3
Figure 3
Receiver operating characteristic curves for IGT, elevated A1C, and IFG. Sensitivity (Sens) and specificity (Spec) were calculated for A1C 5.7% and lower limits of IFG and IGT. For 2-h glucose AUC = 0.689, for A1C AUC = 0.659, and for fasting glucose AUC = 0.612. For differences between AUCs, P = 0.359. ●, 2-h glucose; *, A1C; △, fasting glucose.
Figure 4
Figure 4
Percentage of participants with incident cardiovascular disease and RR (95% CI) of cardiovascular disease in women and men according to glucose status at baseline (n = 516).
See this image and copyright information in PMC

References

    1. International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care 2009;32:1327–1334 - PMC - PubMed
    1. Diagnosis and classification of diabetes mellitus. Diabetes Care 2010;32(Suppl. 1):S62–S67 - PMC - PubMed
    1. Droumaguet C, Balkau B, Simon D, Caces E, Tichet J, Charles MA, Eschwege E: Use of HbA1c in predicting progression to diabetes in French men and women: data from an Epidemiological Study on the Insulin Resistance Syndrome (DESIR). Diabetes Care 2006;29:1619–1625 - PubMed
    1. Edelman D, Olsen MK, Dudley TK, Harris AC, Oddone EZ: Utility of hemoglobin A1c in predicting diabetes risk. J Gen Intern Med 2004;19:1175–1180 - PMC - PubMed
    1. Ko GT, Chan JC, Tsang LW, Cockram CS: Combined use of fasting plasma glucose and HbA1c predicts the progression to diabetes in Chinese subjects. Diabetes Care 2000;23:1770–1773 - PubMed

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