Combined use of fasting plasma glucose and HbA1c predicts the progression to diabetes in Chinese subjects.

Abstract

OBJECTIVE -We have previously suggested using the paired values of fasting plasma glucose (FPG) and HbA 1c to identify potential diabetic subjects. In this article, we followed up on 208 nondiabetic subjects and examined their rates of progression to diabetes. We analyzed their likelihood of becoming diabetic according to their baseline FPG and HbA 1c concentrations. -Between 1988 and 1995, 2,877 Chinese subjects with risk factors for diabetes underwent screening. Of these, 2,250 had FPG Ͻ7.8 mmol/l and 2-h plasma glucose (PG) Ͻ11.1 mmol/l. Of these 2,250 subjects, 265 were randomly recruited for an annual oral glucose tolerance test (OGTT) until they progressed to develop diabetes. Of those 265 subjects, 57 had baseline FPG Ն7.0 mmol/l and were excluded from the present analysis. Hence, the progression of glucose tolerance in 208 subjects who were nondiabetic according to the new American Diabetes Association diagnostic criteria (FPG Ͻ7.0 mmol/l and 2-h PG Ͻ11.1 mmol/l) was examined RESULTS -Of the 208 nondiabetic subjects, 26 (12.5%) were men and 182 (87.5%) were women. After a mean follow-up of 1.60 ± 1.16 years (range 1-7, median 1), 44 (21.2%) progressed to develop diabetes and 164 (78.8%) remained nondiabetic. Those who were diabetic at the end of the study had a high likelihood ratio (LR) of 9.3 to have baseline FPG Ն6.1 mmol/l and baseline HbA 1c Ն6.1%. This was compared with a low LR of 0.6-1.1 in diabetic subjects who had either FPG Ͻ6.1 mmol/l or HbA 1c Ͻ6.1% or both at baseline. The crude rate of progression to diabetes was more than five times higher (44.1 vs. 8.1%) in those whose baseline FPG was Ն6.1 mmol/l and baseline HbA 1c was Ն6.1% compared with those whose baseline FPG was Ͻ6.1 mmol/l and baseline HbA 1c was Ͻ6.1%. RESEARCH DESIGN AND METHODSCONCLUSIONS -For Chinese subjects with risk factors for glucose intolerance, the use of paired FPG and HbA 1c values helped to identify potential diabetic subjects. Those with an FPG Ն6.1 mmol/l and HbA 1c Ն6.1% had a rate of progression to diabetes more than five times higher than those with an FPG Ͻ6.1 mmol/l and an HbA 1c Ͻ6.1% after a mean follow-up of 1.6 years. Those with an FPG Ն6.1 but Ͻ7.0 mmol/l, especially if their HbA 1c was Ն6.1%, should undergo an OGTT to confirm diabetes. Subjects with an FPG Ͻ6.1 mmol/l and/or an HbA 1c Ͻ6.1% should have regular screening using the paired values of FPG and HbA 1c .

Use of HbA1c in Predicting Progression to Diabetes in French Men and Women

“…A study in Pima Indians (15) reported that A1C was an independent predictor for diabetes only in individuals with IGT, not in subjects with normal 2-h plasma glucose. The same relation was found in a Chinese study (16).To determine whether A1C predicted incident diabetes after a 6-year follow-up in a Caucasian population, we analyzed data from the prospective French cohort study: Data from an Epidemiological Study on the Insulin Resistance Syndrome (DESIR).RESEARCH DESIGN AND METHODS -The 3,854 subjects studied, aged 30 -65 years, were included in 1994 -1996 in the DESIR Study, a follow-up study on the development of the insulin resistance syndrome. They were volunteers for a routine health check-up in seven Health Examination Centers financed by the French Social Security in the center-west of France.…”

Estimation of the contribution of biomarkers of different metabolic pathways to risk of type 2 diabetes

“…Previous studies have shown that circulating HbA1c levels are associated with the conversion of pre-diabetic phase into clinical diabetes [35][36][37][38]. Further, a strong association between baseline HbA1c and incidence of type 2 diabetes was also suggested in a large-scale prospective study among middle aged women [39].…”

Evaluation of HbA1c in The Diagnosis of Diabetes

“…Many studies in western literature, have advocated the use of HbA1c for diagnosis of diabetes (5,6,7). When both FPG and A1C were measured, a stronger correlation was found between A1C and retinopathy than between fasting glucose levels and retinopathy (7) Studies that have assessed glycemia with A1C or with single or longitudinal measurements of glucose levels have consistently demonstrated a strong correlation between retinopathy and In our country, patient compliance is a major problem.…”