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. 2011 Mar;34(3):610-5.
doi: 10.2337/dc10-0625. Epub 2011 Feb 2.

Hemoglobin A1c as a predictor of incident diabetes

Peiyao Cheng  1 , Britta Neugaard, Philip Foulis, Paul R Conlin
Affiliations

Hemoglobin A1c as a predictor of incident diabetes

Peiyao Cheng et al. Diabetes Care. 2011 Mar.

Abstract

Objective: Several studies have suggested that HbA(1c) levels may predict incident diabetes. With new recommendations for use of HbA(1c) in diagnosing diabetes, many patients with HbA(1c) results below the diagnostic threshold will be identified. Clinicians will need to categorize risk for a subsequent diabetic diagnosis in such patients. The objective of this study was to determine the ability of HbA(1c) to predict the incidence of a diabetic diagnosis.

Research design and methods: We performed a historical cohort study using electronic medical record data from two Department of Veterans Affairs Medical Centers. Patients (n = 12,589) were identified with a baseline HbA(1c) <6.5% between January 2000 and December 2001 and without a diagnosis of diabetes. Patients (12,375) had at least one subsequent follow-up visit. These patients were tracked for 8 years for a subsequent diagnosis of diabetes.

Results: During an average follow-up of 4.4 years, 3,329 (26.9%) developed diabetes. HbA(1c) ≥ 5.0% carried a significant risk for developing diabetes during follow-up. When compared with the reference group (HbA(1c) <4.5%), HbA(1c) increments of 0.5% between 5.0 and 6.4% had adjusted odds ratios of 1.70 (5.0-5.4%), 4.87 (5.5-5.9%), and 16.06 (6.0-6.4%) (P < 0.0001). Estimates of hazard ratios similarly showed significant increases for HbA(1c) ≥ 5.0%. A risk model for incident diabetes within 5 years was developed and validated using HbA(1c), age, BMI, and systolic blood pressure.

Conclusions: The incidence of diabetes progressively and significantly increased among patients with an HbA(1c) ≥ 5.0%, with substantially expanded risk for those with HbA(1c) 6.0-6.4%.

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Figures

Figure 1
Figure 1
Plot of diabetes event probability against follow-up time, differentiated by baseline HbA1c. The curves for the two lowest groups substantially overlap, but groups with HbA1c ≥5.0% have significantly higher probability of developing diabetes during the 8-year study period (log-rank P value <0.0001).
See this image and copyright information in PMC

References

    1. American Diabetes Association Standards of medical care in diabetes—2010. Diabetes Care 2010;33(Suppl. 1):S11–S61 - PMC - PubMed
    1. American Diabetes Association Diagnosis and classification of diabetes mellitus. Diabetes Care 2009;32(Suppl. 1):S62–S67 - PMC - PubMed
    1. Bennett CM, Guo M, Dharmage SC. HbA1c as a screening tool for detection of Type 2 diabetes: a systematic review. Diabet Med 2007;24:333–343 - PubMed
    1. Peters AL, Davidson MB, Schriger DL, Hasselblad V, Meta-analysis Research Group on the Diagnosis of Diabetes Using Glycated Hemoglobin Levels A clinical approach for the diagnosis of diabetes mellitus: an analysis using glycosylated hemoglobin levels. JAMA 1996;276:1246–1252 - PubMed
    1. Ginde AA, Cagliero E, Nathan DM, Camargo CA., Jr Value of risk stratification to increase the predictive validity of HbA1c in screening for undiagnosed diabetes in the US population. J Gen Intern Med 2008;23:1346–1353 - PMC - PubMed

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