1
|
Moon JS, Kang S, Choi JH, Lee KA, Moon JH, Chon S, Kim DJ, Kim HJ, Seo JA, Kim MK, Lim JH, Song YJ, Yang YS, Kim JH, Lee YB, Noh J, Hur KY, Park JS, Rhee SY, Kim HJ, Kim HM, Ko JH, Kim NH, Kim CH, Ahn J, Oh TJ, Kim SK, Kim J, Han E, Jin SM, Bae J, Jeon E, Kim JM, Kang SM, Park JH, Yun JS, Cha BS, Moon MK, Lee BW. 2023 Clinical Practice Guidelines for Diabetes Management in Korea: Full Version Recommendation of the Korean Diabetes Association. Diabetes Metab J 2024; 48:546-708. [PMID: 39091005 DOI: 10.4093/dmj.2024.0249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 06/20/2024] [Indexed: 08/04/2024] Open
Affiliation(s)
- Jun Sung Moon
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Shinae Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Han Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Kyung Ae Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Korea
| | - Joon Ho Moon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Suk Chon
- Department of Endocrinology and Metabolism, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Hyun Jin Kim
- Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Ji A Seo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Mee Kyoung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeong Hyun Lim
- Department of Food Service and Nutrition Care, Seoul National University Hospital, Seoul, Korea
| | - Yoon Ju Song
- Department of Food Science and Nutrition, The Catholic University of Korea, Bucheon, Korea
| | - Ye Seul Yang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - You-Bin Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Junghyun Noh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Kyu Yeon Hur
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Suk Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Youl Rhee
- Department of Endocrinology and Metabolism, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Hae Jin Kim
- Department of Endocrinology and Metabolism, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Hyun Min Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jung Hae Ko
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Nam Hoon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Chong Hwa Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea
| | - Jeeyun Ahn
- Department of Ophthalmology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Tae Jung Oh
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Soo-Kyung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Jaehyun Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Eugene Han
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Sang-Man Jin
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jaehyun Bae
- Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Eonju Jeon
- Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Ji Min Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Seon Mee Kang
- Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Jung Hwan Park
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jae-Seung Yun
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Bong-Soo Cha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Min Kyong Moon
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Byung-Wan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
2
|
Kim JH, Lee Y, Nam CM, Kwon YJ, Lee JW. Assessing blood sugar measures for predicting new-onset diabetes and cardiovascular disease in community-dwelling adults. Endocrine 2024:10.1007/s12020-024-03876-3. [PMID: 38772989 DOI: 10.1007/s12020-024-03876-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 05/09/2024] [Indexed: 05/23/2024]
Abstract
PURPOSE Diabetes mellitus (DM) is a global health concern linked to various complications, including cardiovascular disease (CVD). However, long-term follow-up studies on the risk of DM and CVD using different blood glucose assessment methods in the general Korean population are lacking. This study aimed to assess the predictive abilities of fasting plasma glucose (FPG), 2-h oral glucose tolerance test (OGTT), and glycosylated hemoglobin (HbA1c) for new-onset DM and high CVD risk in a middle-aged and older Korean population. METHODS This study used data from the Korean Genome and Epidemiology Study, a population-based prospective cohort. Blood sugar measures (FPG, OGTT, and HbA1c) were examined. The primary endpoint was the development of new-onset DM, and CVD risk was evaluated using the Framingham risk score. The predictive abilities for new-onset DM based on glycemic values were evaluated using Harrell's Concordance index and 95% confidence intervals. RESULTS Among the 10,030 participants, data of 6813 participants without DM at baseline were analyzed. The study revealed that OGTT outperformed FPG and HbA1c in predicting new-onset DM. The combination of FPG and HbA1c did not significantly enhance predictions for DM compared with OGTT alone. OGTT also outperformed FPG and HbA1c in predicting high CVD risk, and this difference remained significant even after adjusting for additional confounders. CONCLUSION OGTT has superior predictive capabilities in identifying new-onset DM and high CVD risk in the Korean population. This suggests that relying solely on individual blood sugar measures may be insufficient for assessing DM and CVD risks.
Collapse
Affiliation(s)
- Jung-Hwan Kim
- Department of Family Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - Yaeji Lee
- Department of Biostatistics and Computing, Yonsei University, Seoul, 03722, Republic of Korea
| | - Chung-Mo Nam
- Department of Health Informatics and Biostatistics, Graduate School of Public Health, Yonsei University, Seoul, 03722, Republic of Korea
| | - Yu-Jin Kwon
- Department of Family Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, 16995, Republic of Korea.
| | - Ji-Won Lee
- Department of Family Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea.
- Institute for Innovation in Digital Healthcare, Yonsei University, Seoul, 03722, Republic of Korea.
| |
Collapse
|
3
|
Sitasuwan T, Lertwattanarak R. Prediction of type 2 diabetes mellitus using fasting plasma glucose and HbA1c levels among individuals with impaired fasting plasma glucose: a cross-sectional study in Thailand. BMJ Open 2020; 10:e041269. [PMID: 33172945 PMCID: PMC7656954 DOI: 10.1136/bmjopen-2020-041269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES About 11%-30% of individuals with impaired fasting plasma glucose (IFG) have type 2 diabetes mellitus (T2DM), diagnosed by the 75 g oral glucose tolerance test (75 g OGTT). This study investigated (1) the prevalence and cut-off levels for fasting plasma glucose (FPG) and glycated haemoglobin A1c (HbA1c) in IFG individuals that most effectively predict the presence of T2DM diagnosed by a 75 g OGTT; (2) the predictors associated with T2DM; and (3) the pathophysiological characteristics of patients with IFG. MATERIALS AND METHODS A single-centre, cross-sectional study was conducted in a primary care setting. A standard 75 g OGTT was performed on 123 subjects with IFG. Their beta-cell function and insulin resistance were calculated through plasma glucose and insulin levels monitored during the 75 g OGTT. RESULTS In the IFG subjects, the prevalence of T2DM using the 2-hour postload plasma glucose (2hPG) criterion was 28.5%. Pre-diabetes and normal glucose metabolism were found in 48.7% and 22.8%, respectively, by 75 g OGTT. An HbA1c level ≥6.0% or FPG ≥5.9 mmol/L were the optimal cut-off thresholds for the prediction of the presence of T2DM. HbA1c had a sensitivity of 76.7% and specificity of 55.7% (95% CI 57.7% to 90.1% and 95% CI 43.3% to 67.6%, respectively), while FPG had a sensitivity of 85.7% and specificity of 23.9% (95% CI 69.7% to 95.2% and 95% CI 15.4% to 34.1%, respectively). The presence of metabolic syndrome, a higher HbA1c and higher FPG levels were associated with the risk of T2DM in the Thai IFG population. CONCLUSIONS Almost one-third of the people with IFG had T2DM diagnosed by the 2hPG criterion. HbA1c was more effective than FPG in predicting the presence of T2DM in the IFG subjects. IFG individuals with HbA1c≥6.0% or FPG≥5.9 mmol/L should be advised to undergo a 75 g OGTT to detect T2DM earlier than otherwise.
Collapse
Affiliation(s)
- Tullaya Sitasuwan
- Department of Medicine, Mahidol University Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - Raweewan Lertwattanarak
- Department of Medicine, Mahidol University Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| |
Collapse
|
4
|
Qiu S, Du Z, Li W, Chen J, Wu H, Liu J, Cai M, Wang B, Guo H, Sun Z. Exploration and Validation of the Performance of Hemoglobin A1c in Detecting Diabetes in Community-Dwellers With Hypertension. Ann Lab Med 2020; 40:457-465. [PMID: 32539301 PMCID: PMC7295957 DOI: 10.3343/alm.2020.40.6.457] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/27/2020] [Accepted: 05/27/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Diabetes can complicate hypertension management by increasing the risk of cardiovascular disease (CVD) and all-cause mortality. Studies targeting diabetes detection in hypertensive individuals demonstrating an increased risk of diabetes are lacking. We aimed to assess the performance of hemoglobin A1c (HbA1c) and its cut-off point in detecting diabetes in the abovementioned population. METHODS Data from 4,096 community-dwellers with hypertension but without known diabetes were obtained from the Study on Evaluation of iNnovated Screening tools and determInation of optimal diagnostic cut-off points for type 2 diaBetes in Chinese muLti-Ethnic (SENSIBLE) study; these data were randomly split into exploration (70% of the sample) and internal validation (the remaining 30%) datasets. The optimal HbA1c cut-off point was derived from the exploration dataset and externally validated using another dataset from 2,431 hypertensive individuals. The oral glucose tolerance test was considered the gold-standard for confirming diabetes. RESULTS The areas under the ROC curves for HbA1c to detect diabetes were 0.842, 0.832, and 0.829 for the exploration, internal validation, and external validation datasets, respectively. An optimal HbA1c cut-off point of 5.8% (40 mmol/mol) yielded a sensitivity of 76.2% and a specificity of 74.5%. Individuals who were not diagnosed as having diabetes by HbA1c at 5.8% (40 mmol/mol) had a lower 10-year CVD risk score than those diagnosed as having diabetes (P=0.01). HbA1c≤5.1% (32 mmol/mol) and ≥6.4% (46 mmol/mol) could indicate the absence and presence of diabetes, respectively. CONCLUSIONS HbA1c could detect diabetes effectively in community-dwellers with hypertension.
Collapse
Affiliation(s)
- Shanhu Qiu
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China
| | - Ziwei Du
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China
| | - Wei Li
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China
| | - Juan Chen
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China
| | - Hang Wu
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China
| | - Jingbao Liu
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China
| | - Min Cai
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China
| | - Bei Wang
- School of Public Health, Southeast University, Nanjing, China
| | - Haijian Guo
- Department of Integrated Services, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Zilin Sun
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China
| |
Collapse
|
5
|
Kim MS, Jo DS, Lee DY. Comparison of HbA1c and OGTT for the diagnosis of type 2 diabetes in children at risk of diabetes. Pediatr Neonatol 2019; 60:428-434. [PMID: 30497969 DOI: 10.1016/j.pedneo.2018.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 08/10/2018] [Accepted: 11/02/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the correlation between plasma glucose and HbA1c and the diagnostic accuracy of HbA1c as a screening tool to identify asymptomatic diabetes mellitus in children and adolescents with obesity or asymptomatic glucosuria. METHODS A total of 190 subjects who underwent an oral glucose tolerance test (OGTT) to confirm diabetes were categorized into normal glucose tolerance (NGT; n = 117), impaired glucose tolerance (IGT; n = 33), and diabetes (DM; n = 40) according to the OGTT. Forty-seven patients with DM were diagnosed by either OGTT or HbA1c levels. The diagnostic accuracy for the detection of diabetes is based on 47 patients. Laboratory tests were performed after 12 h of fasting. RESULTS According to the HbA1c criterion, 107 (55.3%) subjects were in the NGT group, 41 (21.6%) were in the IGT group, and 42 (22.1%) were in the DM group. Diagnostic sensitivities of HbA1c and 2-hour plasma glucose level following OGTT (2-h OGTT) for DM were significantly higher than that of fasting plasma glucose, FPG (89.4, 85.1 vs. 63.8%). In addition, the area under the curves of diagnostic criteria was 0.970 for HbA1c, 0.939 for FPG and 0.977 for 2-h OGTT. Mean FPG and 2-h OGTT for HbA1c level >6.5% were 115.2 mg/dL and 181.8 mg/dL, respectively. The optimal HbA1c level cut-off point for predicting DM is 6.15%, with a sensitivity of 95.7% in Korean children and adolescents. CONCLUSION The HbA1c criterion ≥6.5% was adequate to detect DM among Korean children and adolescents with obesity or asymptomatic glucosuria. We also recommend HbA1c level of 6.15% as the optimal cut-off point for detecting DM in Korean children and adolescents.
Collapse
Affiliation(s)
- Min Sun Kim
- Department of Pediatrics, Chonbuk National University Medical School, South Korea; Research Institute of Clinical Medicine of Chonbuk National University- Biomedical Research Institute of Chonbuk National University Hospital, Jeonju 54907, South Korea
| | - Dae Sun Jo
- Department of Pediatrics, Chonbuk National University Medical School, South Korea; Research Institute of Clinical Medicine of Chonbuk National University- Biomedical Research Institute of Chonbuk National University Hospital, Jeonju 54907, South Korea
| | - Dae-Yeol Lee
- Department of Pediatrics, Chonbuk National University Medical School, South Korea; Research Institute of Clinical Medicine of Chonbuk National University- Biomedical Research Institute of Chonbuk National University Hospital, Jeonju 54907, South Korea.
| |
Collapse
|
6
|
Lee J, Lee YA, Kim JH, Lee SY, Shin CH, Yang SW. Discrepancies between Glycosylated Hemoglobin and Fasting Plasma Glucose for Diagnosing Impaired Fasting Glucose and Diabetes Mellitus in Korean Youth and Young Adults. Diabetes Metab J 2019; 43:174-182. [PMID: 30398041 PMCID: PMC6470094 DOI: 10.4093/dmj.2018.0046] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 08/10/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Glycosylated hemoglobin (HbA1c) has been recommended as a diagnostic test for prediabetes and diabetes. Here, we evaluated the level of agreement between diagnoses based on fasting plasma glucose (FPG) versus HbA1c levels and determined optimal HbA1c cutoff values for these diseases in youth and young adults. METHODS The study included 7,332 subjects (n=4,129, aged 10 to 19 years in youth group; and n=3,203 aged 20 to 29 years in young adult group) from the 2011 to 2016 Korea National Health and Nutrition Examination Survey. Prediabetes and diabetes were defined as 100 to 125 mg/dL (impaired fasting glucose [IFG]) and ≥126 mg/dL for FPG (diabetes mellitus [DM] by FPG [DMFPG]), and 5.7% to 6.4% and ≥6.5% for HbA1c, respectively. RESULTS In the youth group, 32.5% with IFG had an HbA1c level of 5.7% to 6.4%, and 72.2% with DMFPG had an HbA1c ≥6.5%. In the young adult group, 27.5% with IFG had an HbA1c level of 5.7% to 6.4%, and 66.6% with DMFPG had an HbA1c ≥6.5%. Kappa coefficients for agreement between the FPG and HbA1c results were 0.12 for the youth group and 0.19 for the young adult group. In receiver operating characteristic curve analysis, the optimal HbA1c cutoff for IFG and DMFPG were 5.6% and 5.9% in youths and 5.5% and 5.8% in young adults, respectively. CONCLUSION Usefulness of HbA1c for diagnosis of IFG and DMFPG in Koreans aged <30 years remains to be determined due to discrepancies between the results of glucose- and HbA1c-based tests. Additional testing might be warranted at lower HbA1c levels to detect IFG and DMFPG in this age group.
Collapse
Affiliation(s)
- Jieun Lee
- Department of Pediatrics, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Young Ah Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Hyun Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
| | - Seong Yong Lee
- Department of Pediatrics, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Choong Ho Shin
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sei Won Yang
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
7
|
Zhou X, Ruan X, Hao L, Zhou Y, Gu J, Qiu H, Wu K, Yu S, Rui X, Wang X, Liu X, Ke J, Zhao G, Sun Q. Optimal hemoglobin A1C cutoff value for diabetes mellitus and pre-diabetes in Pudong New Area, Shanghai, China. Prim Care Diabetes 2018; 12:238-244. [PMID: 29370998 DOI: 10.1016/j.pcd.2017.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 12/19/2017] [Accepted: 12/27/2017] [Indexed: 11/15/2022]
Abstract
AIMS Due to the diversity of the Chinese population, it requires considerable research to evaluate HbA1c diagnostic threshold for diagnosis of hyperglycemia. METHODS We included 7909 subjects aged ≥15 without known diabetes from the baseline of Pudong community cohort in 2013. Participants took oral glucose tolerance test (OGTT) and HbA1c assay. Receiver operating characteristic curve determined the HbA1c threshold in the diagnosis of hyperglycemia. RESULTS The optimal HbA1C threshold for diagnosing newly diagnosed diabetes (NDD) and pre-diabetes in this population was 6.0% (AUC=0.798, 95%CI: 0.779-0.818) and 5.6% (AUC=0.655, 95%CI: 0.638-0.671). When compared with elderly age group (≥70 years), HbA1c for detecting NDD performed better in youth (15-39 years: P=0.003, 40-49 years: P<0.001). There were 13.81% and 13.34% of participants would be newly detected as NDD and pre-diabetes via HbA1c criteria; meanwhile 3.20% and 15.52% diagnosed as NDD and pre-diabetes by OGTT criteria would be missed diagnosis. CONCLUSIONS The optimal HbA1c thresholds for NDD and pre-diabetes were lower than ADA criteria. It is necessary to carefully consider whether choose HbA1c as a diagnostic criterion or combine two diagnostic standards. Age-specific diagnostic thresholds should be considered when HbA1c was recommended as diagnostic standard.
Collapse
Affiliation(s)
- Xianfeng Zhou
- School of Public Health, Fudan University, No. 130, Dongan Road, Shanghai 200032, China; Center for Disease Prevention and Control, Pudong Preventive Medicine Research Institute of Fudan University, Pudong New Area, No. 3039, Zhangyang Road, Shanghai 200136, China
| | - Xiaonan Ruan
- Center for Disease Prevention and Control, Pudong Preventive Medicine Research Institute of Fudan University, Pudong New Area, No. 3039, Zhangyang Road, Shanghai 200136, China
| | - Lipeng Hao
- Center for Disease Prevention and Control, Pudong Preventive Medicine Research Institute of Fudan University, Pudong New Area, No. 3039, Zhangyang Road, Shanghai 200136, China
| | - Yi Zhou
- Center for Disease Prevention and Control, Pudong Preventive Medicine Research Institute of Fudan University, Pudong New Area, No. 3039, Zhangyang Road, Shanghai 200136, China
| | - Jianjun Gu
- Health and Family Planning Commission, Pudong New Area, No. 990, Chengshan Road, 200125 Shanghai, China
| | - Hua Qiu
- Center for Disease Prevention and Control, Pudong Preventive Medicine Research Institute of Fudan University, Pudong New Area, No. 3039, Zhangyang Road, Shanghai 200136, China
| | - Kang Wu
- Center for Disease Prevention and Control, Pudong Preventive Medicine Research Institute of Fudan University, Pudong New Area, No. 3039, Zhangyang Road, Shanghai 200136, China
| | - Siyu Yu
- Center for Disease Prevention and Control, Pudong Preventive Medicine Research Institute of Fudan University, Pudong New Area, No. 3039, Zhangyang Road, Shanghai 200136, China
| | - Xinyi Rui
- Center for Disease Prevention and Control, Pudong Preventive Medicine Research Institute of Fudan University, Pudong New Area, No. 3039, Zhangyang Road, Shanghai 200136, China
| | - Xiaonan Wang
- Center for Disease Prevention and Control, Pudong Preventive Medicine Research Institute of Fudan University, Pudong New Area, No. 3039, Zhangyang Road, Shanghai 200136, China
| | - Xiaolin Liu
- Center for Disease Prevention and Control, Pudong Preventive Medicine Research Institute of Fudan University, Pudong New Area, No. 3039, Zhangyang Road, Shanghai 200136, China
| | - Juzhong Ke
- Center for Disease Prevention and Control, Pudong Preventive Medicine Research Institute of Fudan University, Pudong New Area, No. 3039, Zhangyang Road, Shanghai 200136, China
| | - Genming Zhao
- School of Public Health, Fudan University, No. 130, Dongan Road, Shanghai 200032, China.
| | - Qiao Sun
- Center for Disease Prevention and Control, Pudong Preventive Medicine Research Institute of Fudan University, Pudong New Area, No. 3039, Zhangyang Road, Shanghai 200136, China.
| |
Collapse
|
8
|
Yap CW, Ang YG, Quek TPL, Heng BH, Chew DEK. Re-examining the sensitivity of HbA1c to screen for diabetes mellitus. J Diabetes 2018; 10:380-385. [PMID: 29030996 DOI: 10.1111/1753-0407.12615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 09/18/2017] [Accepted: 10/08/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND One of the laboratory tests recommended by the American Diabetes Association (ADA) to screen for diabetes mellitus (DM) is HbA1c, and it is particularly suitable for segments of the population that cannot or are unwilling to fast for a screening test. The aim of this study was to determine whether HbA1c would be a useful tool to screen for DM in a real-world setting if ADA guidelines for repeat testing to confirm the diagnosis of DM are strictly adhered to. METHODS A retrospective database study was performed by extracting demographic and laboratory data from a chronic disease registry that collects data on adults from three tertiary hospitals and nine large primary care clinics in Singapore. Data were extracted and analyzed for adults not previously known to have DM whose data was captured in the registry between 2005 and 2016 with HbA1c and at least two diagnostic tests for DM (fasting plasma glucose or 2-h plasma glucose) performed within 4 weeks after HbA1c determination. RESULTS In all, 3928 adults were included in this study. The sensitivity, specificity, and area under the receiver operating characteristic curve for HbA1c at a threshold of 6.5% were 85.2%, 82.3%, and 0.914, respectively. A higher sensitivity was found in female adults, younger adults, and those of non-Chinese ethnicity. CONCLUSIONS The sensitivity of HbA1c as a screening test for DM in this study was significantly higher than that reported previously. This work provides additional evidence supporting the inclusion of HbA1c as one of the screening tests for DM.
Collapse
Affiliation(s)
- Chun W Yap
- Health Services and Outcomes Research, National Healthcare Group, Singapore
| | - Yee G Ang
- Health Services and Outcomes Research, National Healthcare Group, Singapore
| | | | - Bee H Heng
- Health Services and Outcomes Research, National Healthcare Group, Singapore
| | - Daniel E K Chew
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore
- Department of Metabolic Medicine, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of General Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|
9
|
Lopez-Lopez J, Garay J, Wandurraga E, Camacho PA, Higuera-Escalante F, Cohen D, Lopez-Jaramillo P. The simultaneous assessment of glycosylated hemoglobin, fasting plasma glucose and oral glucose tolerance test does not improve the detection of type 2 diabetes mellitus in Colombian adults. PLoS One 2018; 13:e0194446. [PMID: 29652881 PMCID: PMC5898701 DOI: 10.1371/journal.pone.0194446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 03/02/2018] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Guidelines recommend early detection of type 2 diabetes mellitus (DM2). The objective of the present study was to evaluate the capacity to identify DM2 in subjects that were screened for DM2 simultaneously with all three of the tests recommended-fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c) and a 2-hour post 75-g oral glucose tolerance test (OGTT). METHODS AND RESULTS The present analysis of an anonymous database of 1113 adults from a reference clinical laboratory in Bucaramanga, Colombia, was an observational, descriptive, cross-sectional secondary source study. 259 individuals met at least one of the criteria for DM2: FPG ≥ 126mg/dL (7.0mmol/L), HbA1c ≥ 6.5% (48mmol/mol) and OGTT ≥ 200mg/dL (11.1mmol/L). 30 subjects (2.7%) were diabetic according to FPG, 56 subjects (5.0%) by HbA1c and 250 subjects (22.5%) by OGTT. In total 259 subjects (23.3% [IC 95%: 20.7%- 25.8%] were diabetic either by FPG, OGTT or HbA1c. DISCUSSION The largest number of patients were identified as diabetic with the OGTT. The combination of two or three tests did not increase the detection of new cases of DM2. Our findings suggest that routinely requesting FPG, OGTT and HbA1c at the same time may be inappropriate in at risk individuals, as this approach does not significantly improve the diagnostic capacity compared to using FPG+OGTT and substantially increases the financial burden on the health system, insurers or individual.
Collapse
Affiliation(s)
- Jose Lopez-Lopez
- Internal Medicine Residence Program, Universidad Autonoma de Bucaramanga (UNAB), Bucaramanga, Colombia
| | - Jennifer Garay
- Internal Medicine Residence Program, Universidad Autonoma de Bucaramanga (UNAB), Bucaramanga, Colombia
| | - Edwin Wandurraga
- Endocrinology Service, Fundación Oftalmológica de Santander—Clínica Carlos Ardila Lulle (FOSCAL), Floridablanca, Colombia
| | - Paul A. Camacho
- Research Department, Fundacion Oftalmologica de Santander (FOSCAL), Floridablanca, Colombia
- Facultad de ciencias de la Salud, Universidad Autonoma de Bucaramanga (UNAB), Bucaramanga, Colombia
| | | | - Daniel Cohen
- Research Department, Fundacion Oftalmologica de Santander (FOSCAL), Floridablanca, Colombia
- MASIRA Institute, Facultad de Salud, Universidad de Santander (UDES), Bucaramanga, Colombia
| | - Patricio Lopez-Jaramillo
- Research Department, Fundacion Oftalmologica de Santander (FOSCAL), Floridablanca, Colombia
- MASIRA Institute, Facultad de Salud, Universidad de Santander (UDES), Bucaramanga, Colombia
- Facultad de ciencias de la Salud, Universidad Autonoma de Bucaramanga (UNAB), Bucaramanga, Colombia
- Facultad de Ciencias de la Salud Eugenio Espejo, Universidad Tecnológica Equinoccial, Quito, Ecuador
| |
Collapse
|
10
|
Joung KH, Ju SH, Kim JM, Choung S, Lee JM, Park KS, Kim HJ, Ku BJ. Clinical Implications of Using Post-Challenge Plasma Glucose Levels for Early Diagnosis of Type 2 Diabetes Mellitus in Older Individuals. Diabetes Metab J 2018; 42:147-154. [PMID: 29676544 PMCID: PMC5911518 DOI: 10.4093/dmj.2018.42.2.147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 11/15/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The aim of this study was to explore the differences in the clinical characteristics and diagnostic rates of diabetes mellitus (DM) according to various criteria in different age groups and to evaluate the efficacy of each criterion for screening older patients. METHODS We studied 515 patients and measured the fasting plasma glucose level (FPG), 2-hour plasma glucose level after the 75 g oral glucose tolerance test (2-hour postload glucose [2-h PG]), and glycosylated hemoglobin (HbA1c) for re-evaluation of hyperglycemia without a history of diabetes. Patients with newly diagnosed DM were grouped by age as younger (<65 years) or older (≥65 years). RESULTS Older patients had significantly lower HbA1c, FPG, and 2-h PG levels and a higher homeostatic level of pancreatic β-cell function compared with younger patients (P<0.001). The older group had the lowest diagnostic rate when using the FPG level (45.5%) and the highest diagnostic rate when using the 2-h PG level (84.6%). These results were mostly due to the higher frequency of isolated post-challenge hyperglycemia in the older patients than in the younger group (28.8% vs. 9.2%). The use of both the FPG and HbA1c levels significantly enhanced the low diagnostic power when employing only the FPG levels in the older group (71.2% vs. 45.5%). CONCLUSION In the older patients, the 2-h PG level was the most accurate diagnostic criterion. When we consider the costs and convenience, a combination of the FPG and HbA1c criteria may be recommended as a screening test for DM in older people.
Collapse
Affiliation(s)
- Kyong Hye Joung
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Sang Hyun Ju
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Ji Min Kim
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Sorim Choung
- Department of Medical Science, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jae Min Lee
- Department of Internal Medicine, Eulji University School of Medicine, Daejeon, Korea
| | - Kang Seo Park
- Department of Internal Medicine, Eulji University School of Medicine, Daejeon, Korea
| | - Hyun Jin Kim
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Bon Jeong Ku
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
- Department of Medical Science, Chungnam National University School of Medicine, Daejeon, Korea.
| |
Collapse
|
11
|
Hong JW, Noh JH, Kim DJ. Association between White Blood Cell Counts within Normal Range and Hemoglobin A1c in a Korean Population. Endocrinol Metab (Seoul) 2018; 33:79-87. [PMID: 29388402 PMCID: PMC5874199 DOI: 10.3803/enm.2018.33.1.79] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 11/29/2017] [Accepted: 12/27/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND We examined whether white blood cell (WBC) count levels within normal range, could be associated with hemoglobin A1c (HbA1c) levels. METHODS Among the 11,472 people (≥19 years of age) who participated in the 2011 to 2012 Korea National Health and Nutrition Examination, subjects with chronic disease or illness, including 807 patients with diabetes currently taking anti-diabetic medications and/or 1,149 subjects with WBC levels <4,000 or >10,000/μL were excluded. RESULTS Overall, adjusted HbA1c levels increased across the WBC quartiles (5.55%±0.01%, 5.58%±0.01%, 5.60%±0.01%, and 5.65%±0.01%, P<0.001) after adjusting for confounding factors, such as age, gender, fasting plasma glucose, college graduation, smoking history, waist circumference, presence of hypertension, serum total cholesterol, serum triglyceride, and presence of anemia. The adjusted proportions (%) of HbA1c levels of ≥5.7%, ≥6.1%, and ≥6.5% showed significant increases across WBC quartiles (P<0.001, P=0.002, and P=0.022, respectively). Logistic regression analyses of WBC quartiles for the risk of HbA1c levels of ≥5.7%, ≥6.1%, and ≥6.5%, using the variables above as covariates, showed that the odds ratios of the fourth quartile of WBCs were 1.59 (95% confidence interval [CI], 1.35 to 1.89; P<0.001), 1.78 (95% CI, 1.31 to 2.42; P<0.001), and 2.03 (95% CI, 1.13 to 3.64; P=0.018), using the first quartile of WBCs as the reference. CONCLUSION HbA1c levels were positively associated with WBC levels within normal range in a general adult population.
Collapse
Affiliation(s)
- Jae Won Hong
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Jung Hyun Noh
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Dong Jun Kim
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.
| |
Collapse
|
12
|
Booth RA, Jiang Y, Morrison H, Orpana H, Rogers Van Katwyk S, Lemieux C. Ethnic dependent differences in diagnostic accuracy of glycated hemoglobin (HbA1c) in Canadian adults. Diabetes Res Clin Pract 2018; 136:143-149. [PMID: 29203254 DOI: 10.1016/j.diabres.2017.11.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 11/03/2017] [Accepted: 11/28/2017] [Indexed: 01/30/2023]
Abstract
AIM Previous studies have shown varying sensitivity and specificity of hemoglobin A1c (HbA1c) to identify diabetes and prediabetes, compared to 2-h oral glucose tolerance testing (OGTT) and fasting plasma glucose (FPG), in different ethnic groups. Within the Canadian population, the ability of HbA1c to identify prediabetes and diabetes in First Nations, Métis and Inuit, East and South Asian ethnic groups has yet to be determined. METHODS We collected demographic, lifestyle information, biochemical results of glycemic status (FPG, OGTT, and HbA1c) from an ethnically diverse Canadian population sample, which included a purposeful sampling of First Nations, Métis, Inuit, South Asian and East Asian participants. RESULTS Sensitivity and specificity using Canadian Diabetes Association (CDA) recommended cut-points varied between ethnic groups, with greater variability for identification of prediabetes than diabetes. Dysglycemia (prediabetes and diabetes) was identified with a sensitivity and specificity ranging from 47.1% to 87.5%, respectively in Caucasians to 24.1% and 88.8% in Inuit. Optimal HbA1c ethnic-specific cut-points for dysglycemia and diabetes were determined by receiver operating characteristic (ROC) curve analysis. CONCLUSIONS Our sample showed broad differences in the ability of HbA1c to identify dysglycemia or diabetes in different ethnic groups. Optimal cut-points for dysglycemia or diabetes in all ethnic groups were substantially lower than CDA recommendations. Utilization of HbA1c as the sole biochemical diagnostic marker may produce varying degrees of false negative results depending on the ethnicity of screened individuals. Further research is necessary to identify and validate optimal ethnic specific cut-points used for diabetic screening in the Canadian population.
Collapse
Affiliation(s)
- Ronald A Booth
- Division of Biochemistry, The Ottawa Hospital, Canada; Department of Pathology and Laboratory Medicine, University of Ottawa, Canada.
| | - Ying Jiang
- Social Determinants and Science Integration Directorate, Public Health Agency of Canada, Canada
| | - Howard Morrison
- Social Determinants and Science Integration Directorate, Public Health Agency of Canada, Canada
| | - Heather Orpana
- Social Determinants and Science Integration Directorate, Public Health Agency of Canada, Canada; School of Psychology, University of Ottawa, Canada
| | - Susan Rogers Van Katwyk
- Social Determinants and Science Integration Directorate, Public Health Agency of Canada, Canada; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Canada
| | - Chantal Lemieux
- Social Determinants and Science Integration Directorate, Public Health Agency of Canada, Canada; School of Psychology, University of Ottawa, Canada
| |
Collapse
|
13
|
Wu L, Lin H, Gao J, Li X, Xia M, Wang D, Aleteng Q, Ma H, Pan B, Gao X. Effect of age on the diagnostic efficiency of HbA1c for diabetes in a Chinese middle-aged and elderly population: The Shanghai Changfeng Study. PLoS One 2017; 12:e0184607. [PMID: 28886160 PMCID: PMC5591004 DOI: 10.1371/journal.pone.0184607] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 08/28/2017] [Indexed: 01/02/2023] Open
Abstract
Background and aims Glycated hemoglobin A1c (HbA1c) ≥6.5% (or 48mmol/mol) has been recommended as a new diagnostic criterion for diabetes; however, limited literature is available regarding the effect of age on the HbA1c for diagnosing diabetes and the causes for this age effect remain unknown. In this study, we investigated whether and why age affects the diagnostic efficiency of HbA1c for diabetes in a community-based Chinese population. Methods In total, 4325 participants without previously known diabetes were enrolled in this study. Participants were stratified by age. Receiver operating characteristic curve (ROC) was plotted for each age group and the area under the curve (AUC) represented the diagnostic efficiency of HbA1c for diabetes defined by the plasma glucose criteria. The area under the ROC curve in each one-year age group was defined as AUCage. Multiple regression analyses were performed to identify factors inducing the association between age and AUCage based on the changes in the β and P values of age. Results The current threshold of HbA1c (≥6.5% or 48mmol/mol) showed low sensitivity (35.6%) and high specificity (98.9%) in diagnosing diabetes. ROC curve analyses showed that the diagnostic efficiency of HbA1c in the ≥75 years age group was significantly lower than that in the 45–54 years age group (AUC: 0.755 vs. 0.878; P<0.001). Pearson correlation analysis showed that the AUCage of HbA1c was negatively correlated with age (r = -0.557, P = 0.001). When adjusting the red blood cell (RBC) count in the multiple regression model, the negative association between age and AUCage disappeared, with the regression coefficient of age reversed to 0.001 and the P value increased to 0.856. Conclusions The diagnostic efficiency of HbA1c for diabetes decreased with aging, and this age effect was induced by the decreasing RBC count with age. HbA1c is unsuitable for diagnosing diabetes in elderly individuals because of their physiologically decreased RBC count.
Collapse
Affiliation(s)
- Li Wu
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China
- Fudan Institute for Metabolic Diseases, Shanghai, China
| | - Huandong Lin
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China
- Fudan Institute for Metabolic Diseases, Shanghai, China
- Research Center on Aging and Medicine, Fudan University, Shanghai, China
| | - Jian Gao
- Department of Clinical Nutrition, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaoming Li
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Mingfeng Xia
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China
- Fudan Institute for Metabolic Diseases, Shanghai, China
| | - Dan Wang
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qiqige Aleteng
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hui Ma
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Baishen Pan
- Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xin Gao
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China
- Fudan Institute for Metabolic Diseases, Shanghai, China
- * E-mail:
| |
Collapse
|
14
|
Kwon S, Na Y. The Cutoff Value of HbA1c in Predicting Diabetes and Impaired Fasting Glucose. KOREAN JOURNAL OF CLINICAL LABORATORY SCIENCE 2017. [DOI: 10.15324/kjcls.2017.49.2.114] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Seyoung Kwon
- Department of Biomedical Laboratory Science, Daegu Health College, Daegu, Korea
| | - Youngak Na
- Department of Biomedical Laboratory Science, Daegu Health College, Daegu, Korea
| |
Collapse
|
15
|
Wang Y, Yuan Y, Zhang Y, Lei C, Zhou Y, He J, Sun Z. Serum 1,5-anhydroglucitol level as a screening tool for diabetes mellitus in a community-based population at high risk of diabetes. Acta Diabetol 2017; 54:425-431. [PMID: 27896445 DOI: 10.1007/s00592-016-0944-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 11/14/2016] [Indexed: 12/12/2022]
Abstract
AIMS Early diagnosis of diabetes yields significant clinical benefits; however, currently available diagnostic tools for community-based population are limited. This study aimed to assess the value of serum 1,5-anhydroglucitol (1,5-AG) for the diagnosis and screening of diabetes mellitus in a community-based population at high risk of diabetes. METHODS In this diagnostic test, 1170 participants underwent a 75-g oral glucose tolerance test. Venous blood samples were collected for fasting blood glucose (FBG), 2-h postprandial blood glucose (PBG), and glycosylated hemoglobin A1c (HbA1c) measurements. Serum 1,5-AG levels were detected by the GlycoMark assay, and a receiver operating characteristic (ROC) curve was generated to assess their diagnostic value for diabetes. RESULTS A total of 298 adults were diagnosed with diabetes, indicating a prevalence of 25.47%. Partial Pearson correlation analysis adjusted for age and body mass index showed that serum 1,5-AG level was negatively correlated with FBG, PBG, and HbA1c (all P < 0.01). Areas under the curves (AUCs) for serum 1,5-AG, FBG, PBG, and HbA1c in identifying diabetes were 0.920, 0.874, 0.933, and 0.887, respectively. According to the ROC curve, the optimal cutoff value of serum 1,5-AG for diagnosing diabetes was 11.18 μg/ml, which yielded a sensitivity of 92.6% and a specificity of 82.3%, respectively. Comparisons between 1,5-AG and HbA1c showed that both the AUC and sensitivity of 1,5-AG were higher than those of HbA1c (both P < 0.01). CONCLUSIONS Serum 1,5-AG is a simple and effective marker with high sensitivity and specificity for identifying diabetes in populations at high risk of diabetes.
Collapse
Affiliation(s)
- Yao Wang
- Department of Endocrinology, Zhongda Hospital Southeast University, Nanjing, China
| | - Yuexing Yuan
- Department of Endocrinology, Zhongda Hospital Southeast University, Nanjing, China
| | - Yanli Zhang
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, Medical School, Southeast University, No. 87 Dingjiaqiao Road, Nanjing, 210009, Jiangsu Province, China
| | - Chenghao Lei
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, Medical School, Southeast University, No. 87 Dingjiaqiao Road, Nanjing, 210009, Jiangsu Province, China
| | - Yi Zhou
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, Medical School, Southeast University, No. 87 Dingjiaqiao Road, Nanjing, 210009, Jiangsu Province, China
| | - Jiajia He
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, Medical School, Southeast University, No. 87 Dingjiaqiao Road, Nanjing, 210009, Jiangsu Province, China
| | - Zilin Sun
- Department of Endocrinology, Zhongda Hospital Southeast University, Nanjing, China.
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, Medical School, Southeast University, No. 87 Dingjiaqiao Road, Nanjing, 210009, Jiangsu Province, China.
| |
Collapse
|
16
|
Diabetes Spatial Care Paths, Leading Edge HbA1c Testing, Facilitation Thresholds, Proactive-Preemptive Strategic Intelligence, and Unmanned Aerial Vehicles in Limited-Resource Countries. ACTA ACUST UNITED AC 2017. [DOI: 10.1097/poc.0000000000000122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
17
|
Hong JW, Noh JH, Kim DJ. Association between Alcohol Intake and Hemoglobin A1c in the Korean Adults: The 2011-2013 Korea National Health and Nutrition Examination Survey. PLoS One 2016; 11:e0167210. [PMID: 27893805 PMCID: PMC5125693 DOI: 10.1371/journal.pone.0167210] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 11/10/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Although alcohol consumption is commonly encountered in clinical practice, few studies have investigated the clinical significance of alcohol intake on the use of the hemoglobin A1c (HbA1c) level. OBJECTIVES This study was performed to investigate the association between alcohol intake and HbA1c level in the general population. METHODS Among the 24,594 participants who participated in the 2011-2013 Korea National Health and Nutrition Examination Survey (KNHANES), 12,923 participants were analyzed in this study. We excluded diabetic patients currently taking antidiabetes medication. We compared the HbA1c level and proportions of patients with an HbA1c level of ≥5.7%, ≥6.1%, and ≥6.5% according to the fasting plasma glucose (FPG) concentration range and the amount of alcohol intake. The average amounts of daily alcohol intake were categorized into three groups: 0 g/day, <30 g/day, ≥30 g/day. RESULTS The mean HbA1c level was 5.65%, and the mean FPG concentration was 95.3 mg/dl. The percentages of patients with an HbA1c level of ≥5.7%, ≥6.1%, and ≥6.5% were 42.6%, 13.4%, and 4.5%, respectively. The average amount of alcohol intake was 12.3 g/day. The percentages of subjects with alcohol intake 0, <30, and ≥ 30 g/day were 16.5%, 69.7%, and 13.8%, respectively. There was a significant positive relationship between alcohol intake and FPG concentration (P < 0.001), the prevalence of impaired fasting glucose (P < 0.001), and the prevalence of diabetes (P < 0.001). However, there was no significant relationship between the alcohol intake and HbA1c level. Overall, the adjusted HbA1c levels decreased across alcohol intake (5.70% ± 0.01%, 5.66% ± 0.01%, and 5.55% ± 0.01%) after adjustment for confounding factors such as age, sex, FPG concentration, college graduation, smoking history, presence of hypertension, waist circumference, serum total cholesterol concentration, serum high-density lipoprotein cholesterol concentration, serum triglyceride concentration, presence of anemia, serum white blood cell count, and serum alanine aminotransferase concentration (P < 0.001). The adjusted proportions (%) of patients with an HbA1c level of ≥5.7% (P < 0.001), ≥6.1% (P < 0.001), and ≥6.5% (P < 0.001) showed significant negative trends across alcohol intake after adjustment for confounders. Logistic regression analyses showed that, when using the group that abstained as the control, the group that consumed ≥ 30g/day was negatively associated with the risk of an HbA1c level of ≥5.7% (P < 0.001), ≥6.1% (P < 0.001), and ≥6.5% (P < 0.001), using the above-mentioned variables as covariates. CONCLUSIONS Higher alcohol intake was associated with lower HbA1c levels, even after adjusting for confounding factors, including the FPG concentration, in this nationally representative sample of Korean adults. These results suggest that excessive drinking shifts the HbA1c level downward, which might complicate use of the HbA1c level for the diagnosis of diabetes or prediabetes.
Collapse
Affiliation(s)
- Jae Won Hong
- Department of Internal Medicine, Ilsan-Paik Hospital, College of Medicine, Inje University, Koyang, Gyeonggi-do, Republic of Korea
| | - Jung Hyun Noh
- Department of Internal Medicine, Ilsan-Paik Hospital, College of Medicine, Inje University, Koyang, Gyeonggi-do, Republic of Korea
| | - Dong-Jun Kim
- Department of Internal Medicine, Ilsan-Paik Hospital, College of Medicine, Inje University, Koyang, Gyeonggi-do, Republic of Korea
- * E-mail:
| |
Collapse
|
18
|
Hong S, Kang JG, Kim CS, Lee SJ, Park CY, Lee CB, Ihm SH. Glycosylated Hemoglobin Threshold for Predicting Diabetes and Prediabetes from the Fifth Korea National Health and Nutrition Examination Survey. Diabetes Metab J 2016; 40:167-70. [PMID: 27126887 PMCID: PMC4853225 DOI: 10.4093/dmj.2016.40.2.167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 09/18/2015] [Indexed: 12/27/2022] Open
Abstract
We aimed to estimate the threshold level of glycosylated hemoglobin (HbA1c) for the fasting plasma glucose of 100 and 126 mg/dL in the Korean adult population, using the 2011 Korea National Health and Nutrition Examination Survey. A total of 4,481 participants over 19 years of age without diabetic medications and conditions to influence the interpretation of HbA1c levels, such as anemia, renal insufficiency, liver cirrhosis, and cancers, were analyzed. A point-wise area under the receiver operating characteristic curve was used to estimate the optimal HbA1c cutoff value. A HbA1c threshold of 6.35% was optimal for predicting diabetes with a sensitivity of 86.9% and a specificity of 99.1%. Furthermore, the threshold of HbA1c was 5.65% for prediabetes, with a sensitivity of 69.3% and a specificity of 71%. Further prospective studies are needed to evaluate the HbA1c cutoff point for diagnosing prediabetes and diabetes in the Korean population.
Collapse
Affiliation(s)
- Sangmo Hong
- Division of Endocrinology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jun Goo Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.
| | - Chul Sik Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Seong Jin Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Cheol Young Park
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chang Beom Lee
- Division of Endocrinology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Sung Hee Ihm
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| |
Collapse
|
19
|
Kim DL, Kim SD, Kim SK, Park S, Song KH. Is an Oral Glucose Tolerance Test Still Valid for Diagnosing Diabetes Mellitus? Diabetes Metab J 2016; 40:118-28. [PMID: 26616592 PMCID: PMC4853219 DOI: 10.4093/dmj.2016.40.2.118] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 08/13/2015] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND We evaluated the diagnostic rate of diabetes using fasting plasma glucose (FPG), 2-hour plasma glucose (2h PG) after 75 g oral glucose tolerance test (OGTT), and glycosylated hemoglobin (HbA1c) levels, and we elucidated the pathophysiologic characteristics and risk factors that give rise to diabetes in patients with prediabetes. METHODS The data of 236 patients who had the OGTT at Konkuk University Hospital were analyzed. Fasting, 30, and 120 minutes blood glucose levels and insulin levels were measured. The diagnostic rate of diabetes was assessed using FPG, 2h PG, and HbA1c levels. The clinical data and insulin resistance and secretion evaluations were compared using indexes according to the fasting glucose level. RESULTS Among 236 subjects, 97 (41.1%) were diabetics and 102 (43.2%) were prediabetics. The rate of diabetes diagnosis by one of the individual criteria was 56.7%, 53.6%, and 84.5% for FPG, HbA1c, and 2h PG, respectively. When two criteria were used to diagnose diabetes, 72.2% of the diabetic patients were identified by FPG and HbA1c, while 100% were identified by FPG and 2h PG, and 91.7% were identified by 2h PG and HbA1c. The HbA1c cut-off value for 2h PG ≥200 mg/dL was 6.1%, and the FPG cut-off value was 115 mg/dL. In impaired fasting glucose subjects, the HbA1c level, Matsuda index, and insulinogenic index were associated with risk of occurrence of overt diabetes (P<0.01). CONCLUSION This study suggests that performing additional OGTT for patients with FPG ≥110 mg/dL or HbA1c ≥6.1% is helpful to reclassify their glucose tolerance status and evaluate their potential for progressing to overt diabetes.
Collapse
Affiliation(s)
- Dong Lim Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Sun Doo Kim
- Department of Internal Medicine, Graduate School of Medicine, Konkuk University, Seoul, Korea
| | - Suk Kyeong Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Sooyoun Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Kee Ho Song
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.
| |
Collapse
|
20
|
Hong S, Kang JG, Kim CS, Lee SJ, Lee CB, Ihm SH. Comparison of the clinical characteristics of diabetes mellitus diagnosed using fasting plasma glucose and haemoglobin A1c: The 2011 Korea National Health and Nutrition Examination Survey. Diabetes Res Clin Pract 2016; 113:23-5. [PMID: 26972956 DOI: 10.1016/j.diabres.2016.01.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 01/18/2016] [Accepted: 01/22/2016] [Indexed: 12/16/2022]
Abstract
We compared the characteristics of a Korean adult population diagnosed with diabetes using only a fasting plasma glucose criterion or an HbA1c criterion. The single difference between these two groups was age. Further studies should be undertaken to clarify whether age-specific diagnostic criteria would be appropriate in Korean populations.
Collapse
Affiliation(s)
- Sangmo Hong
- Division of Endocrinology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Jun Goo Kang
- Division of Endocrinology and Metabolism, Hallym University Sacred Heart Hospital, Gyeonggi-do, Republic of Korea.
| | - Chul Sik Kim
- Division of Endocrinology and Metabolism, Hallym University Sacred Heart Hospital, Gyeonggi-do, Republic of Korea
| | - Seong Jin Lee
- Division of Endocrinology and Metabolism, Hallym University Sacred Heart Hospital, Gyeonggi-do, Republic of Korea
| | - Chang Beom Lee
- Division of Endocrinology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Sung-Hee Ihm
- Division of Endocrinology and Metabolism, Hallym University Sacred Heart Hospital, Gyeonggi-do, Republic of Korea
| |
Collapse
|
21
|
Abstract
Globally, the incidence of diabetes mellitus is rising at an alarming rate and has become a health crisis that threatens the economies of all nations. Therefore, diagnosing diabetes has become an important issue in the management of diabetes. Glycated hemoglobin (HbA1c) is now recommended as a means to diagnose diabetes, but its use still has limitations. In this article, the biology, measurement, standardization, and opportunities and challenges of the use of HbA1c to diagnose diabetes are reviewed. More specifically, its use in China and the Asian region is discussed in detail.
Collapse
Affiliation(s)
- Weiping Jia
- a Department of Endocrinology and Metabolism , Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease , Shanghai , China
| |
Collapse
|
22
|
Karnchanasorn R, Huang J, Ou HY, Feng W, Chuang LM, Chiu KC, Samoa R. Comparison of the Current Diagnostic Criterion of HbA1c with Fasting and 2-Hour Plasma Glucose Concentration. J Diabetes Res 2016; 2016:6195494. [PMID: 27597979 PMCID: PMC4997021 DOI: 10.1155/2016/6195494] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 07/17/2016] [Accepted: 07/19/2016] [Indexed: 01/26/2023] Open
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.
Collapse
Affiliation(s)
- Rudruidee Karnchanasorn
- Division of Endocrinology, Department of Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Jean Huang
- Department of Clinical Diabetes, Endocrinology, and Metabolism, City of Hope National Medical Center, Duarte, CA 91010, USA
- Division of Endocrinology, Metabolism and Nutrition, Department of Internal Medicine, Harbor-UCLA Medical Center, Torrance, CA 90502, USA
| | - Horng-Yih Ou
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei Feng
- Department of Clinical Diabetes, Endocrinology, and Metabolism, City of Hope National Medical Center, Duarte, CA 91010, USA
- Division of Endocrinology, Metabolism and Nutrition, Department of Internal Medicine, Harbor-UCLA Medical Center, Torrance, CA 90502, USA
| | - Lee-Ming Chuang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Preventive Medicine, School of Public Health, National Taiwan University, Taipei, Taiwan
| | - Ken C. Chiu
- Department of Clinical Diabetes, Endocrinology, and Metabolism, City of Hope National Medical Center, Duarte, CA 91010, USA
- Division of Endocrinology, Metabolism and Nutrition, Department of Internal Medicine, Harbor-UCLA Medical Center, Torrance, CA 90502, USA
- *Ken C. Chiu:
| | - Raynald Samoa
- Department of Clinical Diabetes, Endocrinology, and Metabolism, City of Hope National Medical Center, Duarte, CA 91010, USA
- Division of Endocrinology, Metabolism and Nutrition, Department of Internal Medicine, Harbor-UCLA Medical Center, Torrance, CA 90502, USA
| |
Collapse
|
23
|
Hong S, Kang JG, Kim CS, Lee SJ, Lee CB, Ihm SH. Fasting plasma glucose concentrations for specified HbA1c goals in Korean populations: data from the Fifth Korea National Health and Nutrition Examination Survey (KNHANES V-2, 2011). Diabetol Metab Syndr 2016; 8:62. [PMID: 27579145 PMCID: PMC5004334 DOI: 10.1186/s13098-016-0179-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 08/17/2016] [Indexed: 11/10/2022] Open
Abstract
AIMS To examine the correlation between the fasting plasma glucose and HbA1c levels using regression equation and to assess the average fasting plasma glucose levels for the specific HbA1c (A1C) goals in the patients with diabetes using each A1C-and fasting plasma glucose-based diagnostic criteria. METHODS This study included data from 4481 participants with A1C and fasting plasma glucose, but with no diabetic medications in the Korean National Health and Nutritional Examination Survey 2011. The correlation between fasting plasma glucose and A1C was examined using linear regression models. RESULTS The A1C levels corresponding to the fasting plasma glucose of 5.5 and 7 mmol/L were 5.75 and 6.42 %. However, in the subjects with diabetes diagnosed by the A1C criteria only, 5.5 and 7 mmol/L in the fasting plasma glucose predicted A1C of 6.49 and 7.14 % respectively. The average fasting plasma glucose levels to achieve specified A1C levels of 5.0-5.9, 6.0-6.9, 7.0-7.9, 8.0-8.9, and 9.0-9.9 % were 5.1, 6.1, 7.7, 8.8 and 11.2 mmol/L, respectively. CONCLUSIONS The association between A1C and fasting plasma glucose levels is in concordance with the existing criteria for diagnosis of diabetes. However, the average fasting plasma glucose concentrations to achieve targeted A1C may be lower than those in western populations.
Collapse
Affiliation(s)
- Sangmo Hong
- Division of Endocrinology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, 7, Keunjaebong-gil,Hwaseong-si, Gyeonggi-do, 445-907, Republic of Korea
| | - Jun Goo Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 896 Pyeongchon-dong, Dongan-gu, Anyang, Gyeonggi-do Republic of Korea
| | - Chul Sik Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 896 Pyeongchon-dong, Dongan-gu, Anyang, Gyeonggi-do Republic of Korea
| | - Seong Jin Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 896 Pyeongchon-dong, Dongan-gu, Anyang, Gyeonggi-do Republic of Korea
| | - Chang Beom Lee
- Department of Endocrinology and Metabolism, Hanyang University Guri Hospital, Gyomun 1(il)-dong, Guri-si, Gyeonggi-do 471-701 Republic of Korea
| | - Sung-Hee Ihm
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 896 Pyeongchon-dong, Dongan-gu, Anyang, Gyeonggi-do Republic of Korea
| |
Collapse
|
24
|
Effects of diabetes definition on global surveillance of diabetes prevalence and diagnosis: a pooled analysis of 96 population-based studies with 331,288 participants. Lancet Diabetes Endocrinol 2015; 3:624-37. [PMID: 26109024 PMCID: PMC4673089 DOI: 10.1016/s2213-8587(15)00129-1] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 04/23/2015] [Accepted: 04/29/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Diabetes has been defined on the basis of different biomarkers, including fasting plasma glucose (FPG), 2-h plasma glucose in an oral glucose tolerance test (2hOGTT), and HbA1c. We assessed the effect of different diagnostic definitions on both the population prevalence of diabetes and the classification of previously undiagnosed individuals as having diabetes versus not having diabetes in a pooled analysis of data from population-based health examination surveys in different regions. METHODS We used data from 96 population-based health examination surveys that had measured at least two of the biomarkers used for defining diabetes. Diabetes was defined using HbA1c (HbA1c ≥6·5% or history of diabetes diagnosis or using insulin or oral hypoglycaemic drugs) compared with either FPG only or FPG-or-2hOGTT definitions (FPG ≥7·0 mmol/L or 2hOGTT ≥11·1 mmol/L or history of diabetes or using insulin or oral hypoglycaemic drugs). We calculated diabetes prevalence, taking into account complex survey design and survey sample weights. We compared the prevalences of diabetes using different definitions graphically and by regression analyses. We calculated sensitivity and specificity of diabetes diagnosis based on HbA1c compared with diagnosis based on glucose among previously undiagnosed individuals (ie, excluding those with history of diabetes or using insulin or oral hypoglycaemic drugs). We calculated sensitivity and specificity in each survey, and then pooled results using a random-effects model. We assessed the sources of heterogeneity of sensitivity by meta-regressions for study characteristics selected a priori. FINDINGS Population prevalence of diabetes based on FPG-or-2hOGTT was correlated with prevalence based on FPG alone (r=0·98), but was higher by 2-6 percentage points at different prevalence levels. Prevalence based on HbA1c was lower than prevalence based on FPG in 42·8% of age-sex-survey groups and higher in another 41·6%; in the other 15·6%, the two definitions provided similar prevalence estimates. The variation across studies in the relation between glucose-based and HbA1c-based prevalences was partly related to participants' age, followed by natural logarithm of per person gross domestic product, the year of survey, mean BMI, and whether the survey population was national, subnational, or from specific communities. Diabetes defined as HbA1c 6·5% or more had a pooled sensitivity of 52·8% (95% CI 51·3-54·3%) and a pooled specificity of 99·74% (99·71-99·78%) compared with FPG 7·0 mmol/L or more for diagnosing previously undiagnosed participants; sensitivity compared with diabetes defined based on FPG-or-2hOGTT was 30·5% (28·7-32·3%). None of the preselected study-level characteristics explained the heterogeneity in the sensitivity of HbA1c versus FPG. INTERPRETATION Different biomarkers and definitions for diabetes can provide different estimates of population prevalence of diabetes, and differentially identify people without previous diagnosis as having diabetes. Using an HbA1c-based definition alone in health surveys will not identify a substantial proportion of previously undiagnosed people who would be considered as having diabetes using a glucose-based test. FUNDING Wellcome Trust, US National Institutes of Health.
Collapse
|
25
|
Hong JW, Ku CR, Noh JH, Ko KS, Rhee BD, Kim DJ. Association between Self-Reported Smoking and Hemoglobin A1c in a Korean Population without Diabetes: The 2011-2012 Korean National Health and Nutrition Examination Survey. PLoS One 2015; 10:e0126746. [PMID: 26011526 PMCID: PMC4444290 DOI: 10.1371/journal.pone.0126746] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 04/07/2015] [Indexed: 12/12/2022] Open
Abstract
Background Several Western studies have revealed that among non-diabetics, glycosylated hemoglobin A1c (HbA1c) levels are higher in smokers than non-smokers. While studies conducted in Western populations consistently support this association, a recent meta-analysis reported that studies carried out in non-Western populations, including studies of Chinese, Egyptian, and Japanese-Americans, did not detect any significant differences in HbA1c levels between smokers and non-smokers. Objectives We assessed the association between smoking habits and HbA1c levels in the general Korean adult population using data from the Korean National Health and Nutrition Examination Survey (KNHANES) performed in 2011–2012. Methods A total of 10,241 participants (weighted n=33,946,561 including 16,769,320 men and 17,177,241 women) without diabetes were divided into four categories according to their smoking habits: never smokers (unweighted n/ weighted n= 6,349/19,105,564), ex-smokers (unweighted n/ weighted n= 1,912/6,207,144), current light smokers (<15 cigarettes per day, unweighted n/ weighted n=1,205/5,130,073), and current heavy smokers (≥15 cigarettes per day, unweighted n/ weighted n=775/3,503,781). Results In age- and gender-adjusted comparisons, the HbA1c levels of each group were 5.52 ± 0.01% in non-smokers, 5.49 ± 0.01% in ex-smokers, 5.53 ± 0.01% in light smokers, and 5.61 ± 0.02% in heavy smokers. HbA1c levels were significantly higher in light smokers than in ex-smokers (p = 0.033), and in heavy smokers compared with light smokers (p < 0.001). The significant differences remained after adjusting for age, gender, fasting plasma glucose, heavy alcohol drinking, hematocrit, college graduation, and waist circumference. Linear regression analyses for HbA1c using the above-mentioned variables as covariates revealed that a significant association between current smoking and HbA1c (coefficient 0.021, 95% CI 0.003–0.039, p = 0.019). Conclusions Current smoking was independently associated with higher HbA1c levels in a cigarette exposure-dependent manner in a representative population of Korean non-diabetic adults. In this study, we have observed an association between smoking status and HbA1c levels in non-diabetics drawn from a non-Western population, consistent with previous findings in Western populations.
Collapse
Affiliation(s)
- Jae Won Hong
- Department of Internal Medicine, Ilsan-Paik Hospital, College of Medicine, Inje University, Koyang, Gyeonggi-do, South Korea
| | - Cheol Ryong Ku
- Endocrinology, Yonsei University College of Medicine, Seoul, South Korea
| | - Jung Hyun Noh
- Department of Internal Medicine, Ilsan-Paik Hospital, College of Medicine, Inje University, Koyang, Gyeonggi-do, South Korea
| | - Kyung Soo Ko
- Department of Internal Medicine, Sanggye Paik Hospital, Cardiovascular and Metabolic Disease Center, College of Medicine, Inje University, Seoul, Republic of Korea
| | - Byoung Doo Rhee
- Department of Internal Medicine, Sanggye Paik Hospital, Cardiovascular and Metabolic Disease Center, College of Medicine, Inje University, Seoul, Republic of Korea
| | - Dong-Jun Kim
- Department of Internal Medicine, Ilsan-Paik Hospital, College of Medicine, Inje University, Koyang, Gyeonggi-do, South Korea
- * E-mail:
| |
Collapse
|
26
|
Hong JW, Ku CR, Noh JH, Ko KS, Rhee BD, Kim DJ. Association between the presence of iron deficiency anemia and hemoglobin A1c in Korean adults: the 2011-2012 Korea National Health and Nutrition Examination Survey. Medicine (Baltimore) 2015; 94:e825. [PMID: 25997055 PMCID: PMC4602861 DOI: 10.1097/md.0000000000000825] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Few studies have investigated the clinical effect of iron deficiency anemia (IDA) on the use of the Hemoglobin A1c (HbA1c) as a screening parameter for diabetes or prediabetes. We investigated the association between IDA and HbA1c levels in Korean adults.Among the 11,472 adults (≥19 years of age) who participated in the 2011-2012 Korea National Health and Nutrition Examination Survey (a cross-sectional and nationally representative survey conducted by the Korean Center for Disease Control for Health Statistics), 807 patients with diabetes currently taking anti-diabetes medications were excluded from this study. We compared the weighted HbA1c levels and weighted proportion (%) of HbA1c levels of ≥5.7%, ≥6.1%, and ≥6.5% according to the range of fasting plasma glucose (FPG) levels and the presence of IDA.Among 10,665 participants (weighted n = 35,229,108), the prevalence of anemia and IDA was 7.3% and 4.3%, respectively. The HbA1c levels were higher in participants with IDA (5.70% ± 0.02%) than in normal participants (5.59% ± 0.01%; P < 0.001), whereas there was no significant difference in FPG levels. In participants with an FPG level of <100 mg/dL and 100 to 125 mg/dL, the weighted HbA1c level was higher in those with IDA (5.59% ± 0.02% and 6.00% ± 0.05%) than in normal participants (5.44% ± 0.01% and 5.82% ± 0.01%) after adjusting for confounders such as age, sex, FPG level, heavy alcohol drinking, waist circumference, and smoking status as well as after exclusion of an estimated glomerular filtration rate of <60 mL/min/1.73 m (P < 0.001, <0.01). The weighted proportions (%) of an HbA1c level of ≥5.7% and ≥6.1% were also higher in participants with IDA than in normal participants (P < 0.001, <0.05). However, the weighted HbA1c levels in individuals with an FPG level ≥126 mg/dL and a weighted proportion (%) of an HbA1c level of ≥6.5% showed no significant differences according to the presence of IDA.In conclusion, the presence of IDA shifted the HbA1c level upward only in the normoglycemic and prediabetic ranges, not in the diabetic range. Therefore, IDA should be considered before using HbA1c as a screening test for prediabetes.
Collapse
Affiliation(s)
- Jae W Hong
- From the Department of Internal Medicine, Ilsan-Paik Hospital, College of Medicine, Inje University, Koyang, Gyeonggi-do, Republic of Korea; (JWH, JHN, D-JK); Endocrinology, Yonsei University College of Medicine, Seoul, South Korea (CRK) and Department of Internal Medicine, Sanggye Paik Hospital, Cardiovascular and Metabolic Disease Center, College of Medicine, Inje University, Seoul, Republic of Korea (KSK, BDR)
| | | | | | | | | | | |
Collapse
|
27
|
Zhang Y, Hu G, Zhang L, Mayo R, Chen L. A novel testing model for opportunistic screening of pre-diabetes and diabetes among U.S. adults. PLoS One 2015; 10:e0120382. [PMID: 25790106 PMCID: PMC4366186 DOI: 10.1371/journal.pone.0120382] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 01/21/2015] [Indexed: 12/25/2022] Open
Abstract
Objective The study aim was to evaluate the performance of a novel simultaneous testing model, based on the Finnish Diabetes Risk Score (FINDRISC) and HbA1c, in detecting undiagnosed diabetes and pre-diabetes in Americans. Research Design and Methods This cross-sectional analysis included 3,886 men and women (≥ 20 years) without known diabetes from the U.S. National Health and Nutrition Examination Survey (NHANES) 2005-2010. The FINDRISC was developed based on eight variables (age, BMI, waist circumference, use of antihypertensive drug, history of high blood glucose, family history of diabetes, daily physical activity and fruit & vegetable intake). The sensitivity, specificity, and the receiver operating characteristic (ROC) curve of the testing model were calculated for undiagnosed diabetes and pre-diabetes, determined by oral glucose tolerance test (OGTT). Results The prevalence of undiagnosed diabetes was 7.0% and 43.1% for pre-diabetes (27.7% for isolated impaired fasting glucose (IFG), 5.1% for impaired glucose tolerance (IGT), and 10.3% for having both IFG and IGT). The sensitivity and specificity of using the HbA1c alone was 24.2% and 99.6% for diabetes (cutoff of ≥6.5%), and 35.2% and 86.4% for pre-diabetes (cutoff of ≥5.7%). The sensitivity and specificity of using the FINDRISC alone (cutoff of ≥9) was 79.1% and 48.6% for diabetes and 60.2% and 61.4% for pre-diabetes. Using the simultaneous testing model with a combination of FINDRISC and HbA1c improved the sensitivity to 84.2% for diabetes and 74.2% for pre-diabetes. The specificity for the simultaneous testing model was 48.4% of diabetes and 53.0% for pre-diabetes. Conclusions This simultaneous testing model is a practical and valid tool in diabetes screening in the general U.S. population.
Collapse
Affiliation(s)
- Yurong Zhang
- The First Affiliated Hospital of Medical School, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Gang Hu
- Pennington Biomedical Research Center, Baton Rouge, LA, United States of America
| | - Lu Zhang
- Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, United States of America
| | - Rachel Mayo
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States of America
| | - Liwei Chen
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States of America
- * E-mail:
| |
Collapse
|
28
|
Chan CL, Pyle L, Newnes L, Nadeau KJ, Zeitler PS, Kelsey MM. Continuous glucose monitoring and its relationship to hemoglobin A1c and oral glucose tolerance testing in obese and prediabetic youth. J Clin Endocrinol Metab 2015; 100:902-10. [PMID: 25532041 PMCID: PMC4333034 DOI: 10.1210/jc.2014-3612] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
CONTEXT The optimal screening test for diabetes and prediabetes in obese youth is controversial. OBJECTIVE We examined whether glycosylated hemoglobin (HbA1c) or the oral glucose tolerance test (OGTT) is a better predictor of free-living glycemia as measured by continuous glucose monitoring (CGM). DESIGN This was a cross-sectional study of youth 10-18 years old, body mass index (BMI) 85th percentile or greater, with diabetes risk factors. SETTING AND PARTICIPANTS Participants (n = 118) with BMI 85th percentile or greater, not on medications for glucose management, were recruited from primary care and pediatric endocrinology clinics around Denver, Colorado. INTERVENTION HbA1c, fasting plasma glucose, and 2-hour glucose were collected and all participants wore a blinded CGM for 72 hours. MAIN OUTCOME MEASURES CGM outcomes were determined and descriptive statistics calculated. Performance characteristics at current American Diabetes Association cutpoints were compared with CGM outcomes. RESULTS CGM data were successfully collected on 98 obese youth. Those with prediabetes had significantly higher average glucose, area under the curve (AUC), peak glucose, and time greater than 120 and greater than 140 mg/dL (P < .01) on CGM than youth with normal HbA1c or OGTT. HbA1c had a greater magnitude of correlation to CGM average glucose, AUC, and minimum glucose; 2-hour glucose had a greater magnitude of correlation to CGM SD, peak glucose, and time greater than 140 and greater than 200 mg/dL. However, there were no overall differences in the strength comparisons between 2-hour glucose and HbA1c correlations to CGM outcomes. CONCLUSIONS In obese youth, HbA1c and 2-hour glucose performed equally well at predicting free-living glycemia on CGM, suggesting that both are valid tests for dysglycemia screening.
Collapse
Affiliation(s)
- Christine L Chan
- Department of Pediatrics, Division of Pediatric Endocrinology (C.L.C., L.N., K.J.N., P.S.Z., M.M.K.), and Department of Pediatrics, Administrative Division (L.P.), University of Colorado Denver, Aurora, Colorado 80045
| | | | | | | | | | | |
Collapse
|
29
|
Abstract
With standardization of measurement of glycated hemoglobin (A1C), the International Expert Committee Report in 2009 and the American Diabetes Association in 2010 recommended incorporating A1C ≥6.5% into the previous diagnostic criteria using fasting plasma glucose and/or 2-hour plasma glucose. Whereas the association of A1C with cardiovascular diseases and other diabetic microvascular complications was linear without evidence of a distinct threshold, several studies suggested a threshold value for A1C in diabetic retinopathy (DR). In studies about the optimal cutoff value for A1C in DR, the A1C values range from 5.2% to 7.8%. There are several possible reasons why these values for DR differ so widely (differences in the definition and/or methods for DR, variation in statistical methods, differences in study population, differences in exclusion criteria, and difference in methods for measuring A1C). With these wide variations in the study method, drawing a conclusive cutoff value for A1C in DR is impossible. In published studies, the cutoff values for moderate or severe DR were higher than those for any or mild DR (6.4% to 7.0% vs. 5.5% to 6.5%).
Collapse
Affiliation(s)
- Jung Min Kim
- Department of Internal Medicine, Cardiovascular and Metabolic Disease Center, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Dong-Jun Kim
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| |
Collapse
|
30
|
Shimodaira M, Okaniwa S, Hanyu N, Nakayama T. Optimal Hemoglobin A1c Levels for Screening of Diabetes and Prediabetes in the Japanese Population. J Diabetes Res 2015; 2015:932057. [PMID: 26114121 PMCID: PMC4465763 DOI: 10.1155/2015/932057] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 05/18/2015] [Indexed: 01/12/2023] Open
Abstract
The aim of this study was to evaluate the utility of hemoglobin A1c (HbA1c) to identify individuals with diabetes and prediabetes in the Japanese population. A total of 1372 individuals without known diabetes were selected for this study. A 75 g oral glucose tolerance test (OGTT) was used to diagnose diabetes and prediabetes. The ability of HbA1c to detect diabetes and prediabetes was investigated using receiver operating characteristic (ROC) analysis. The kappa (κ) coefficient was used to test the agreement between HbA1c categorization and OGTT-based diagnosis. ROC analysis demonstrated that HbA1c was a good test to identify diabetes and prediabetes, with areas under the curve of 0.918 and 0.714, respectively. Optimal HbA1c cutoffs for diagnosing diabetes and prediabetes were 6.0% (sensitivity 83.7%, specificity 87.6%) and 5.7% (sensitivity 60.6%, specificity 72.1%), respectively, although the cutoff for prediabetes showed low accuracy (67.6%) and a high false-negative rate (39.4%). Agreement between HbA1c categorization and OGTT-based diagnosis was low in diabetes (κ = 0.399) and prediabetes (κ = 0.324). In Japanese subjects, the HbA1c cutoff of 6.0% had appropriate sensitivity and specificity for diabetes screening, whereas the cutoff of 5.7% had modest sensitivity and specificity in identifying prediabetes. Thus, HbA1c may be inadequate as a screening tool for prediabetes.
Collapse
Affiliation(s)
- Masanori Shimodaira
- Department of Internal Medicine, Iida Municipal Hospital, 438 Yawata-machi, Iida, Nagano 395-8502, Japan
| | - Shinji Okaniwa
- Department of Internal Medicine, Iida Municipal Hospital, 438 Yawata-machi, Iida, Nagano 395-8502, Japan
| | - Norinao Hanyu
- Department of Internal Medicine, Iida Municipal Hospital, 438 Yawata-machi, Iida, Nagano 395-8502, Japan
| | - Tomohiro Nakayama
- Division of Companion Diagnostics, Department of Pathology of Microbiology, Nihon University School of Medicine, 30-1 Ooyaguchi-kamimachi, Itabashi-ku, Tokyo 173-8610, Japan
- *Tomohiro Nakayama:
| |
Collapse
|
31
|
Kim JM, Hong JW, Won JC, Noh JH, Ko KS, Rhee BD, Kim DJ. Glycated Hemoglobin Value for Fasting Plasma Glucose of 126 mg/dL in Korean: The 2011 Korea National Health and Nutrition Examination Survey. Diabetes Metab J 2014; 38:480-3. [PMID: 25541612 PMCID: PMC4273035 DOI: 10.4093/dmj.2014.38.6.480] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 04/02/2014] [Indexed: 11/18/2022] Open
Abstract
We aimed to estimate the cutoff value of glycated hemoglobin (HbA1c, A1c) for fasting plasma glucose (FPG) of 126 mg/dL in the Korean adult population, using the 2011 Korea National Health and Nutrition Examination Survey. A total of 5,421 participants without a history of diabetes and over 19 years of age were included in the analysis. A point-wise area under the receiver operating characteristic curve was used to estimate the optimal A1c cutoff value. A1c threshold of 6.1% produced the highest sum of sensitivity (85.2%) and specificity (90.5%) for FPG of 126 mg/dL (area under the curve, 0.941, P<0.001). A1c of 6.5% produced a sensitivity of 67.7% and specificity of 98.0% for FPG of 126 mg/dL. Considering A1c as one of three criteria for the diagnosis of diabetes and the specificity of an A1c cutoff of 6.5%, the current diagnostic criteria of A1c≥6.5% might be acceptable in the Korean adult population.
Collapse
Affiliation(s)
- Jung Min Kim
- Department of Internal Medicine, Cardiovascular and Metabolic Disease Center, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jae Won Hong
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Jong Chul Won
- Department of Internal Medicine, Cardiovascular and Metabolic Disease Center, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jung Hyun Noh
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Kyung Soo Ko
- Department of Internal Medicine, Cardiovascular and Metabolic Disease Center, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Byoung Doo Rhee
- Department of Internal Medicine, Cardiovascular and Metabolic Disease Center, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Dong-Jun Kim
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| |
Collapse
|