Utility of HbA<sub>1c</sub> and fasting plasma glucose for screening of Type 2 diabetes: a meta‐analysis of full <scp>ROC</scp> curves

Hoyer, Annika; Rathmann, Wolfgang; Kuß, Oliver

doi:10.1111/dme.13560

Cited by 18 publications

(16 citation statements)

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“…Our results found a lower sensitivity but slightly higher specificity for FPG (126mg/dl or 7mmol/l) detecting diabetes in undiagnosed persons than estimated by another meta-analysis [38]. Our finding of optimal cut-off of HbA1c as 6.03% for diagnosis of diagnosis in previously undiagnosed population lies within the range suggested by a previous work [18,21]; and close to optimal cut-off (6.0%) estimated by a number of included cross-sectional studies [40][41][42][43][44]. We found the certainty of evidence for the optimal threshold for sensitivity and specificity for HbA1c (6.03%) as of moderate quality (S6 Table in S1 File).…”

Section: Plos Onesupporting

confidence: 80%

“…A metaanalysis by Kodama in 2013 included studies using abnormal A1c and FPG values for diagnosing and predicting diabetes [20]. Using data from previous two systematic reviews [18,20], a meta-analytical comparison of HbA1c and FPG was done by Hoyer in 2018 [21]. Another published meta-analysis reported on the summary estimates for diagnostic accuracy for HbA1c for prediabetes [19].…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic accuracy of tests for type 2 diabetes and prediabetes: A systematic review and meta-analysis

et al. 2020

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Aim This systematic review aimed to ascertain the diagnostic accuracy (sensitivity and specificity) of screening tests for early detection of type 2 diabetes and prediabetes in previously undiagnosed adults. Methods This systematic review included published studies that included one or more index tests (random and fasting tests, HbA1c) for glucose detection, with 75-gram Oral Glucose Tolerance Test (or 2-hour post load glucose) as a reference standard (PROSPERO ID CRD42018102477). Seven databases were searched electronically (from their inception up to March 9, 2020) accompanied with bibliographic and website searches. Records were manually screened and full text were selected based on inclusion and exclusion criteria. Subsequently, data extraction was done using standardized form and quality assessment of studies using QUADAS-2 tool. Meta-analysis was done using bivariate model using Stata 14.0. Optimal cut offs in terms of sensitivity and specificity for the tests were analysed using R software. Results Of 7,151 records assessed by title and abstract, a total of 37 peer reviewed articles were included in this systematic review. The pooled sensitivity, specificity, positive (LR+) and negative likelihood ratio (LR-) for diagnosing diabetes with HbA1c (6.5%; venous sample; n = 17 studies) were 50% (95% CI: 42–59%), 97.3% (95% CI: 95.3–98.4), 18.32 (95% CI: 11.06–30.53) and 0.51 (95% CI: 0.43–0.60), respectively. However, the optimal cut-off for diagnosing diabetes in previously undiagnosed adults with HbA1c was estimated as 6.03% with pooled sensitivity of 73.9% (95% CI: 68–79.1%) and specificity of 87.2% (95% CI: 82–91%). The optimal cut-off for Fasting Plasma Glucose (FPG) was estimated as 104 milligram/dL (mg/dL) with a sensitivity of 82.3% (95% CI: 74.6–88.1%) and specificity of 89.4% (95% CI: 85.2–92.5%). Conclusion Our findings suggest that at present recommended threshold of 6.5%, HbA1c is more specific and less sensitive in diagnosing the newly detected diabetes in undiagnosed population from community settings. Lowering of thresholds for HbA1c and FPG to 6.03% and 104 mg/dL for early detection in previously undiagnosed persons for screening purposes may be considered.

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Section: Plos Onesupporting

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of tests for type 2 diabetes and prediabetes: A systematic review and meta-analysis

et al. 2020

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“…FPG is the fastest and simplest test used to diagnose diabetes. It also plays a role in ongoing monitoring of blood glucose control for patients with T2DM [ 29 ]. However, FPG is not the best indicator of diabetes risk.…”

Section: Discussionmentioning

confidence: 99%

Serum Irisin Levels and Clinical Implication in Elderly Patients With Type 2 Diabetes Mellitus

Xuan¹,

Lin²,

Zhang³

et al. 2020

J Clin Med Res

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Background The aim of this study is to evaluate the level and role of serum irisin in elderly patients with type 2 diabetes mellitus (T2DM) using case-control study. Methods A total of 71 patients with T2DM were selected as the case group according to the inclusion criteria and exclusion criteria; and the ratio of 1:1 was calculated according to the inclusion rate of the residents. The cohort established in Guankou Town, Jimei District, Xiamen City, Fujian Province, China and the residents of this cohort were selected at the age of 60 and above. A total of 71 healthy subjects were included as the control group with the same gender and the age with a difference of ± 5 years old. The clinical data of the subjects were collected to determine their previous history, blood pressure, body mass index (BMI), hemoglobin (HB), liver function test, renal function test, fasting blood glucose and serum lipid. The irisin level in serum was measured by enzyme-linked immunosorbent assay (ELISA). The data were analyzed by using SPSS17.0 software. Single factor analysis using Chi-square test or t -test was performed to compare the differences between T2DM patients with the control group of the general data, clinical indicators and irisin level in serum. Logistic regression was used to analyze the protective factors and risk factors of diabetes mellitus. Results The results of single factor analysis showed that the level of irisin in T2DM group was significantly lower than that in the control group (703.37 ± 241.51 ng/mL and 800.22 ± 275.59 ng/mL, respectively). The levels of BMI, systolic blood pressure (SBP), diastolic blood pressure (DBP), triglyceride (TG) and fasting plasma glucose (FPG) in T2DM group were higher than those in control group, and differences were statistically significant. Logistic regression analysis indicated that irisin may be a protective factor for type 2 diabetes (odds ratio (OR) = 0.997, 95% confidence interval (CI): 0.994 - 0.999). Conclusions The serum irisin level in T2DM group was significantly lower than that in control group, suggesting that irisin may be a protective factor for type 2 diabetes.

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“…The performance of HbA 1c in detecting diabetes has received substantial interest [ 11 , 12 , 23 , 24 ]. In a systematic review of nine studies, Bennett, et al [ 11 ] suggested that HbA 1c at 6.1% (43 mmol/mol) could be employed as the optimal cut-off point for detecting diabetes but argued that population-specific cut-offs may vary by the population prevalence of diabetes.…”

Section: Discussionmentioning

confidence: 99%

Exploration and Validation of the Performance of Hemoglobin A1c in Detecting Diabetes in Community-Dwellers With Hypertension

Qiu

et al. 2020

Ann Lab Med

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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 A 1c (HbA 1c ) 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 HbA 1c 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 HbA 1c to detect diabetes were 0.842, 0.832, and 0.829 for the exploration, internal validation, and external validation datasets, respectively. An optimal HbA 1c 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 HbA 1c at 5.8% (40 mmol/mol) had a lower 10-year CVD risk score than those diagnosed as having diabetes ( P =0.01). HbA 1c ≤5.1% (32 mmol/mol) and ≥6.4% (46 mmol/mol) could indicate the absence and presence of diabetes, respectively. Conclusions HbA 1c could detect diabetes effectively in community-dwellers with hypertension.

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Utility of HbA_1c and fasting plasma glucose for screening of Type 2 diabetes: a meta‐analysis of full ROC curves

Abstract: In our meta-analysis, we found that the optimal threshold with reference to the 2 h-PG should be chosen between 42 and 44 mmol/mol (6.0-6.2%) for HbA , and 6.2-6.4 mmol/l for fasting plasma glucose on the basis of maximal sensitivity and specificity.

Cited by 18 publications

References 15 publications

Diagnostic accuracy of tests for type 2 diabetes and prediabetes: A systematic review and meta-analysis

Diagnostic accuracy of tests for type 2 diabetes and prediabetes: A systematic review and meta-analysis

Serum Irisin Levels and Clinical Implication in Elderly Patients With Type 2 Diabetes Mellitus

Exploration and Validation of the Performance of Hemoglobin A1c in Detecting Diabetes in Community-Dwellers With Hypertension

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Utility of HbA1c and fasting plasma glucose for screening of Type 2 diabetes: a meta‐analysis of full ROC curves

Abstract: In our meta-analysis, we found that the optimal threshold with reference to the 2 h-PG should be chosen between 42 and 44 mmol/mol (6.0-6.2%) for HbA , and 6.2-6.4 mmol/l for fasting plasma glucose on the basis of maximal sensitivity and specificity.

Cited by 18 publications

References 15 publications

Diagnostic accuracy of tests for type 2 diabetes and prediabetes: A systematic review and meta-analysis

Diagnostic accuracy of tests for type 2 diabetes and prediabetes: A systematic review and meta-analysis

Serum Irisin Levels and Clinical Implication in Elderly Patients With Type 2 Diabetes Mellitus

Exploration and Validation of the Performance of Hemoglobin A1c in Detecting Diabetes in Community-Dwellers With Hypertension

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Utility of HbA_1c and fasting plasma glucose for screening of Type 2 diabetes: a meta‐analysis of full ROC curves