The Utility of HbA1c as a Diagnostic Criterion of Diabetes.
10.4082/kjfm.2011.32.7.383
- Author:
Hee Jung KIM
1
;
Eun Young CHOI
;
Eal Whan PARK
;
Yoo Seock CHEONG
;
Hong Yoen LEE
;
Ji Hyun KIM
Author Information
1. Department of Family Medicine, Dankook University College of Medicine, Cheonan, Korea. choiey@dku.edu
- Publication Type:Original Article
- Keywords:
Diabetes;
Hemoglobin A, Glycosylated;
Diagnosis;
Glucose Tolerance Test
- MeSH:
Fasting;
Glucose;
Glucose Tolerance Test;
Hemoglobin A, Glycosylated;
Hemoglobins;
Homeostasis;
Humans;
Insulin Resistance;
Plasma;
Prevalence;
ROC Curve;
Sensitivity and Specificity
- From:Korean Journal of Family Medicine
2011;32(7):383-389
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: Hemoglobin A1c (HbA1c) was adopted as a new standard criterion for diagnosing diabetes. We investigated the diagnostic utility of HbA1c by comparing the 2003 American Diabetes Association (ADA) diagnostic criteria of diabetes with HbA1c of 6.5%. Furthermore, the cut-off value for HbA1c was investigated using receiver operating characteristic curves. METHODS: This study included 224 subjects without a history of diabetes that had a fasting plasma glucose level of above 100 mg/dL. The subjects had undergone a 75 g oral glucose tolerance test, and diabetes was defined as according to 2003 ADA criteria. RESULTS: The prevalence of newly diagnosed diabetes was 58.2% by the 2003 ADA criteria, and 47.8% by HbA1c of 6.5%, which underestimated the prevalence of diabetes. Compared with the 2003 ADA criteria, the sensitivity and specificity of HbA1c of 6.5% were 73.5% and 89.1%, respectively. The kappa index of agreement between 2003 ADA and HbA1c criteria was 0.60. The cut-off point of HbA1c for diagnosing diabetes was 6.45% (sensitivity, 73.3%; specificity, 88.2%; area under the curve, 0.85). HbA1c was significantly associated with fasting glucose (r = 0.82, P < 0.01), postprandial glucose (r = 0.78, P < 0.01), and homeostasis model assessment of insulin resistance (r = 0.16, P < 0.05). CONCLUSION: For high risk patients whose fasting glucose was more than 100 mg/dL, HbA1c criterion underestimated the prevalence of newly diagnosed diabetes compared to the 2003 ADA criteria, and showed moderate agreement. The cut-off value for HbA1c was 6.45%, which was similar to the recommended diagnostic criterion of HbA1c by the 2009 ADA.
