The potential impact and optimal cut-points of using glycated haemoglobin, HbA1c, to detect people with impaired glucose regulation in a UK multi-ethnic cohort

Mostafa, Samiul; Khunti, Kamlesh; Srinivasan, Balasubramanian Thiagarajan; Webb, David R.; Gray, Laura J.; Davies, Melanie J.

doi:10.1016/j.diabres.2010.06.008

Cited by 55 publications

(46 citation statements)

References 25 publications

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“…In screening for prediabetes, 2 h‐PPG has an AUC value >0.9, suggesting a high diagnostic value, followed by FPG and HbA1c with values between 0.7–0.9 and <0.7, respectively. The AUC of HbA1c was also similar to the previously reported values of 0.69 (European Caucasians) and 0.72 (South Asians) for people aged 40–75 years in a multi‐ethnic cohort study in Great Britain30. In summary, 2 h‐PPG is the best method to screen for diabetes and prediabetes.…”

Section: Discussionsupporting

confidence: 87%

Ideal glycated hemoglobin cut‐off points for screening diabetes and prediabetes in a Chinese population

Liu

Xiao

Sun

et al. 2016

J of Diabetes Invest

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Aims/IntroductionThe aims of the present study were to evaluate the diagnostic value of fasting plasma glucose, 2‐h postload plasma glucose and glycosylated hemoglobin (HbA1c) measurements in the screening of diabetes and prediabetes, and to determine the cut‐off point of HbA1c in the diagnosis of diabetes and prediabetes in a Chinese population.Materials and MethodsA total of 7,611 individuals aged 40 years or older, who did not have a prior history of diabetes, were randomly selected in the Changchun area. For each participant, a questionnaire was completed, and a physical examination and an oral glucose tolerance test were carried out. The values of fasting plasma glucose, 2‐h postload plasma glucose and HbA1c were compared by area under the receiver operating characteristic curves. The Youden index was used to identify the optimal cut‐off point of HbA1c in the diagnosis of diabetes and prediabetes.ResultsThe prevalence of newly diagnosed diabetes and prediabetes was 12.71% and 29.39%, respectively. In participants with newly diagnosed diabetes, the area under the receiver operating characteristic curve was 0.8368 for fasting plasma glucose, 0.9330 for 2‐h postload plasma glucose and 0.8064 for HbA1c; whereas for prediabetes, these values were 0.8022, 0.9288 and 0.6895, respectively. In addition, an HbA1c threshold of 6.3% showed the highest Youden index (0.4799) for detecting diabetes; furthermore, an HbA1c threshold of 5.8% showed the highest Youden index (0.2866) for detecting prediabetes.ConclusionsHbA1c ≥6.3% (45 mmol/mol) and between 5.8% and 6.2% (40–44 mmol/mol) were the optimal cut‐off values for the diagnosis of diabetes and prediabetes, respectively, in a Chinese population.

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Section: Discussionsupporting

confidence: 87%

Ideal glycated hemoglobin cut‐off points for screening diabetes and prediabetes in a Chinese population

Liu

Xiao

Sun

et al. 2016

J of Diabetes Invest

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“…The Expert Committee defined individuals with an HbA1c between 6.0% and 6.5% as being at high risk of diabetes [11]; subsequently, in January 2010 a new threshold of 5.7% was published in the ADA recommendations [10]. A recent study of Caucasian Europeans proposed that the most appropriate cut-point, using receiver operating characteristic (ROC) curves for the identification of IFG or IGT, was 5.8% [22]. The limits found by the change-point method in our analyses were lower (5.1% in Inter99, 2 mmol/l using again, the criteria of maximizing sensitivity and specificity [25].…”

Section: 7% 12/01/2012mentioning

confidence: 99%

HbA1c, fasting plasma glucose and the prediction of diabetes: Inter99, AusDiab and D.E.S.I.R.

Soulimane

Simon

Shaw

et al. 2012

Diabetes Research and Clinical Practice

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“…21,22 Methods and data collection has been described previously. 8,[21][22][23] In summary, primary care individuals without prior diabetes were invited to a screening appointment. All participants underwent an OGTT (75 g oral load) and had an HbA1c measurement in either a specialist hospital, general practice or on a mobile screening unit.…”

Section: Methodsmentioning

confidence: 99%

Diagnostic performance of using one- or two-HbA1c cut-point strategies to detect undiagnosed type 2 diabetes and impaired glucose regulation within a multi-ethnic population

Mostafa

Khunti

et al. 2012

Diabetes and Vascular Disease Research

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Introduction:We compared test performance and cost per case for strategies detecting diabetes on the oral glucose tolerance test (OGTT) using either (a) glycated haemoglobin (HbA1c) ≥ 6.5% (48 mmol/mol) or (b) two HbA1c thresholds where the first cut-point 'rules out' and the second 'rules in' diabetes. HbA1c values in between the thresholds require confirmatory glucose testing for diagnosis. Materials and methods:We conducted an analysis of adults aged 40-75 years from the Leicester Ethnic Atherosclerosis and Diabetes Risk (LEADER) cohort (Leicester, UK), from 2002 to 2008, who underwent oral glucose tolerance testing (OGTT) and HbA1c testing. Results: From 8696 individuals (mean age 57.3 years, 73% white Europeans (WE) and 27% South Asians (SA)), HbA1c ≥ 6.5% produced sensitivity of 62.1% for detecting diabetes in WE and 78.9% in SA. Using two selected thresholds, HbA1c ≤ 5.8% (rule-in, 40 mmol/mol) and HbA1c ≥ 6.8% (rule-out, 51 mmol/mol) produced high sensitivity/specificity (> 91.0%) for detecting diabetes, however, 28.8% of the cohort with HbA1c 5.9%-6.7% required a subsequent glucose test. The two cut-point threshold produced a lower cost per case of diabetes detected in WE, compared to HbA1c≥ 6.5% of £38.53 (1.89 to 86.81) per case, but was more expensive in SA by £84.50 (69.72 to 100.92) per case. Using a risk score to determine HbA1c testing, the same costs per case became £63.33 (23.33 to 113.26) in WE and £69.21 (55.60 to 82.41) in SA. Conclusion: Using a two-threshold strategy may have some benefits over a single cut-point; however, 28.8% of individuals required two blood tests.

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The potential impact and optimal cut-points of using glycated haemoglobin, HbA1c, to detect people with impaired glucose regulation in a UK multi-ethnic cohort

Cited by 55 publications

References 25 publications

Ideal glycated hemoglobin cut‐off points for screening diabetes and prediabetes in a Chinese population

Ideal glycated hemoglobin cut‐off points for screening diabetes and prediabetes in a Chinese population

HbA1c, fasting plasma glucose and the prediction of diabetes: Inter99, AusDiab and D.E.S.I.R.

Diagnostic performance of using one- or two-HbA1c cut-point strategies to detect undiagnosed type 2 diabetes and impaired glucose regulation within a multi-ethnic population

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