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Comparative Study
. 2016:2016:6195494.
doi: 10.1155/2016/6195494. Epub 2016 Aug 11.

Comparison of the Current Diagnostic Criterion of HbA1c with Fasting and 2-Hour Plasma Glucose Concentration

Rudruidee Karnchanasorn  1 , Jean Huang  2 , Horng-Yih Ou  3 , Wei Feng  2 , Lee-Ming Chuang  4 , Ken C Chiu  2 , Raynald Samoa  2
Affiliations
Comparative Study

Comparison of the Current Diagnostic Criterion of HbA1c with Fasting and 2-Hour Plasma Glucose Concentration

Rudruidee Karnchanasorn et al. J Diabetes Res. 2016.

Abstract

To determine the effectiveness of hemoglobin A1c (HbA1c) ≥ 6.5% in diagnosing diabetes compared to fasting plasma glucose (FPG) ≥ 126 mg/dL and 2-hour plasma glucose (2hPG) ≥ 200 mg/dL in a previously undiagnosed diabetic cohort, we included 5,764 adult subjects without established diabetes for whom HbA1c, FPG, 2hPG, and BMI measurements were collected. Compared to the FPG criterion, the sensitivity of HbA1c ≥ 6.5% was only 43.3% (106 subjects). Compared to the 2hPG criterion, the sensitivity of HbA1c ≥ 6.5% was only 28.1% (110 subjects). Patients who were diabetic using 2hPG criterion but had HbA1c < 6.5% were more likely to be older (64 ± 15 versus 60 ± 15 years old, P = 0.01, mean ± STD), female (53.2% versus 38.2%, P = 0.008), leaner (29.7 ± 6.1 versus 33.0 ± 6.6 kg/m(2), P = 0.000005), and less likely to be current smokers (18.1% versus 29.1%, P = 0.02) as compared to those with HbA1c ≥ 6.5%. The diagnostic agreement in the clinical setting revealed the current HbA1c ≥ 6.5% is less likely to detect diabetes than those defined by FPG and 2hPG. HbA1c ≥ 6.5% detects less than 50% of diabetic patients defined by FPG and less than 30% of diabetic patients defined by 2hPG. When the diagnosis of diabetes is in doubt by HbA1c, FPG and/or 2hPG should be obtained.

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Figures

Figure 1
Figure 1
Sampling scheme.
Figure 2
Figure 2
Percent of diabetic subjects by 2-hour plasma glucose criterion with HbA1c < 6.5% (48 mmol/mol) stratified by body mass index (a) and by age group (b). ∗ P < 0.05 when compared to the group with BMI < 25 kg/m2 in (a); ∗ P < 0.05 when compared to the group with age ≥ 70 years in (b).
Figure 3
Figure 3
Correlation of HbA1c with fasting plasma glucose. Solid line represents the regression line. Dotted lines represent 95% confidence interval. HbA1c (%) = 3.1151 + 0.0232 × FPG (mg/dL).
Figure 4
Figure 4
The fitted receiver operating characteristic curve of HbA1c against FPG. Solid line represents the fitted ROC. Dotted lines represent 95% confidence interval.
Figure 5
Figure 5
Correlation of HbA1c with 2-hour plasma glucose. Solid line represents the regression line. Dotted lines represent 95% confidence intervals of the regressive line. HbA1c (%) = 4.6500 + 0.0067 × 2hPG (mg/dL).
Figure 6
Figure 6
The fitted receiver operating characteristic curve of HbA1c against 2-hour plasma glucose.
See this image and copyright information in PMC

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