Combined Use of a Fasting Plasma Glucose Concentration and HbA1c or Fructosamine Predicts the Likelihood of Having Diabetes in High-Risk Subjects

Ko, G. T. C.; Chan, Juliana C.N.; Yeung, Vincent; Chow, Chun‐Chung; Tsang, L. W. W.; Li, June K.Y.; So, Winnie K.W.; Wai, H. P. S.; Cockram, Clive S.

doi:10.2337/diacare.21.8.1221

Cited by 110 publications

(90 citation statements)

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“…The effect of using measurement of HbA 1c to determine the need for an OGTT generally gave similar results to the protocols that used FPG alone, and 12-27% of people required an OGTT. The optimal cut point for HbA 1c was 5.3%, which is similar to the 5.5% value reported by Ko et al (13). However, the protocols that used an increased FPG cut point or an HbA 1c measurement to determine the need for an OGTT substantially reduced the detection rate of IGT.…”

Section: Discussionsupporting

confidence: 64%

Screening for Type 2 Diabetes and Impaired Glucose Metabolism

Colagiuri

Hussain

Zimmet³

et al. 2004

Diabetes Care

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OBJECTIVE -To assess the Australian protocol for identifying undiagnosed type 2 diabetes and impaired glucose metabolism. RESEARCH DESIGN AND METHODS -TheAustralian screening protocol recommends a stepped approach to detecting undiagnosed type 2 diabetes based on assessment of risk status, measurement of fasting plasma glucose (FPG) in individuals at risk, and further testing according to FPG. The performance of and variations to this protocol were assessed in a population-based sample of 10,508 Australians.RESULTS -The protocol had a sensitivity of 79.9%, specificity of 79.9%, and a positive predictive value (PPV) of 13.7% for detecting undiagnosed type 2 diabetes and sensitivity of 51.9% and specificity of 86.7% for detecting impaired glucose tolerance (IGT) or impaired fasting glucose (IFG). To achieve these diagnostic rates, 20.7% of the Australian adult population would require an oral glucose tolerance test (OGTT). Increasing the FPG cut point to 6.1 mmol/l (110 mg/dl) or using HbA 1c instead of FPG to determine the need for an OGTT in people with risk factors reduced sensitivity, increased specificity and PPV, and reduced the proportion requiring an OGTT. However, each of these protocol variations substantially reduced the detection of IGT or IFG.CONCLUSIONS -The Australian screening protocol identified one new case of diabetes for every 32 people screened, with 4 of 10 people screened requiring FPG measurement and 1 in 5 requiring an OGTT. In addition, 1 in 11 people screened had IGT or IFG. Including HbA 1c measurement substantially reduced both the number requiring an OGTT and the detection of IGT or IFG. Diabetes Care 27:367-371, 2004T ype 2 diabetes is a common and serious condition that is associated with reduced life expectancy and considerable morbidity. It may remain undetected for a number of years, and, consequently, a significant proportion of people with newly diagnosed type 2 diabetes has established complications at the time of diagnosis (1,2).The role of early detection of undiagnosed type 2 diabetes in asymptomatic individuals as a strategy to reduce the personal, public, and economic cost of type 2 diabetes has been extensively reviewed (3). Although there is some circumstantial evidence that earlier detection is associated with improved outcomes (4), definitive evidence of benefit is lacking. Despite this, early detection of type 2 diabetes continues to be recommended by a number of organizations (5,6).In Australia, the National Health and Medical Research Council has recently endorsed a national evidence-based guideline for case detection and diagnosis of type 2 diabetes (7). This guideline was developed through an extensive and systematic review of the literature. It recommends a stepped approach to the diagnosis of people with previously undiagnosed type 2 diabetes based on assessment of an individual's risk status, measurement of fasting plasma glucose (FPG) in individuals at risk, and further testing according to the FPG result (Fig. 1).Since the release of the findings of the Fin...

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Section: Discussionsupporting

confidence: 64%

Screening for Type 2 Diabetes and Impaired Glucose Metabolism

Colagiuri

Hussain

Zimmet³

et al. 2004

Diabetes Care

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“…In conclusion, the paired values of cFruct with FBG or RBG could be utilized in avoiding unnecessary OGTT in a large number of cases as suggested earlier (25,31,36,37). Moreover, since the cFruct is a reliable test for understanding the shortterm glycemic history the strategy of paired values can also be utilized for the subsequent monitoring of GDM.…”

Section: Discussionmentioning

confidence: 95%

“…The individual performance of these tests for filtering hyperglycemic subjects using the above respective cut-off value was as follows: FBG alone (81 subjects), RBG alone (62 subjects) and cFruct alone (42 subjects). Various cut-off values of both FBG (29,31,36) and serum fructosamine (23,36,37) have been used to maintain a balance between false-positive and false-negative results. Agarwal and Punnose (25) pointed out that FBG alone can eliminate the need for 57.8% OGTTs by using the cut-off values of FBG t 5.3 mmol/ L to rule-in GDM and FBG < 4.4 mmol/L to rule-out GDM.…”

Section: Discussionmentioning

confidence: 99%

Paired values of serum fructosamine and blood glucose for the screening of gestational diabetes mellitus: A retrospective study of 165 Saudi pregnant women

Khan

Sobki

Alhomida

et al. 2007

Indian J Clin Biochem

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“…1 Recently, there have been studies undertaken to examine the use of HbA1c as both a screening and a diagnostic test. [5][6][7] An HbA1c is an outcome measurement of the process where glucose binds to haemoglobin in blood. 8 The level of HbA1c formation is a direct measure of glucose in the blood and is expressed as a percentage.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a new diabetes screening method at the Derbarl Yerrigan Health Service

McAullay

Sibthorpe

Knuiman

2004

Australian and New Zealand Journal of Public Health

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Background and Objectives: Diabetes is a major health problem for the Aboriginal population of Australia. Early detection is a key strategy to reduce the burden of diabetes. The aim of this study was to assess the acceptability, sensitivity and specificity, effectiveness and cost of a new method of screening for diabetes at Derbarl Yerrigan, the Aboriginal health service in Perth. Methods: Between January and May 1999, all clients over the age of 30 years and not known to have diabetes were approached for HbA1c testing using the DCA 2000 analyser. Those whose HbA1c results indicated the need for follow‐up were asked to return for confirmatory testing using the gold standard oral glucose tolerance test (OGTT). A questionnaire was administered to participants who did not return. A file audit was conducted over 15 non‐consecutive days to determine screening, follow‐up and the number of new cases diagnosed using the previous ad hoc approach to screening with a glucometer. Result: 238 clients were approached and all agreed to participate and undertook the test. Of these, 37 were referred for follow‐up diagnostic testing. Of these, only 14 had an OGTT. Among these 14, five were found to have diabetes and three were found to have impaired glucose tolerance. Of the remaining 23 participants, we were able to contact only six and administer the questionnaire to four. Poor follow‐up meant that the sensitivity, specificity and cost‐effectiveness of the test could not be assessed. Conclusions and Implications: The reasons for poor follow‐up need to be investigated if Aboriginal health services are to be more successful at screening for diabetes.

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Combined Use of a Fasting Plasma Glucose Concentration and HbA1c or Fructosamine Predicts the Likelihood of Having Diabetes in High-Risk Subjects

Cited by 110 publications

References 1 publication

Screening for Type 2 Diabetes and Impaired Glucose Metabolism

Screening for Type 2 Diabetes and Impaired Glucose Metabolism

Paired values of serum fructosamine and blood glucose for the screening of gestational diabetes mellitus: A retrospective study of 165 Saudi pregnant women

Evaluation of a new diabetes screening method at the Derbarl Yerrigan Health Service

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