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. 2014 Sep;348(3):191-4.
doi: 10.1097/MAJ.0000000000000223.

Low positive predictive value of hemoglobin A1c for diagnosis of prediabetes in clinical practice

Aidar R Gosmanov  1 , Jim Wan
Affiliations

Low positive predictive value of hemoglobin A1c for diagnosis of prediabetes in clinical practice

Aidar R Gosmanov et al. Am J Med Sci. 2014 Sep.

Abstract

Background: Positive predictive value (PPV) of hemoglobin A1c (HbA1c) for diagnosis of prediabetes in clinical practice has not been well studied.

Methods: In a prospective study, patients diagnosed with prediabetes based on HbA1c (5.7%-6.4%) underwent a 75-g oral glucose tolerance test (OGTT) as the gold standard test to diagnose dysglycemia. Demographics, anthropometrics, comorbidity, concomitant prescription medications and biochemical data were collected.

Results: We identified 66 patients with HbA1c-based prediabetes with a mean HbA1c of 6.00 ± 0.20%. However, based on the OGTT, 32 had normal glucose tolerance (NGT), 26 had prediabetes and 8 had diabetes yielding a PPV of HbA1c of 39.4%. In univariate analysis, the patients with the OGTT-based prediabetes administered more medications for associated medical problems compared with the NGT group (5.9 ± 2.2 versus 2.6 ± 1.8, P < 0.0001). After adjustment for baseline variables, the medication use remained significantly different between OGTT-based prediabetes and NGT groups (P = 0.041).

Conclusions: PPV of HbA1c for diagnosis of prediabetes in clinical setting is low. Patients with HbA1c of 5.7% to 6.4% should undergo OGTT to confirm diagnosis of dysglycemia.

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