HbA1c Cutoff Point of 5.9% Better Identifies High Risk of Progression to Diabetes among Chinese Adults: Results from a Retrospective Cohort Study

Autor: Aixia Ma, Zeqiang Ma, Tianyi He, Fei Yan, Xiuping Zhang, Chuan Wang, Kai Liang, Chengqiao Li, Weifang Yang, Lingshu Wang, Xinguo Hou, Li Chen
Rok vydání: 2017
Předmět:
Blood Glucose
Male
endocrine system diseases
Endocrinology
Diabetes and Metabolism
Youden's J statistic
lcsh:Diseases of the endocrine glands. Clinical endocrinology
0302 clinical medicine
Endocrinology
030212 general & internal medicine
Prediabetes
Aged
80 and over
Glucose tolerance test
medicine.diagnostic_test
Incidence
Middle Aged
Postprandial Period
Predictive value of tests
Area Under Curve
Disease Progression
Female
Research Article
Adult
Risk
medicine.medical_specialty
China
Article Subject
030209 endocrinology & metabolism
Sensitivity and Specificity
Prediabetic State
03 medical and health sciences
Asian People
Predictive Value of Tests
Internal medicine
Diabetes mellitus
medicine
Humans
Aged
Retrospective Studies
Glycated Hemoglobin
lcsh:RC648-665
business.industry
Clinical Laboratory Techniques
Reproducibility of Results
Retrospective cohort study
Glucose Tolerance Test
medicine.disease
Confidence interval
Diabetes Mellitus
Type 2
ROC Curve
Relative risk
business
Zdroj: Journal of Diabetes Research
Journal of Diabetes Research, Vol 2018 (2018)
ISSN: 2314-6753
Popis: Aims. This article performed a retrospective cohort study to estimate the annual incidence rates of diabetes and to assess the utility of HbA1c as a predictor for progression to diabetes in Chinese community adults aged 40 years or older. Methods. In all, 2778 nondiabetic subjects (including 1901 women) underwent HbA1c testing and oral glucose tolerance test (OGTT) measurements at baseline and after 3 years. Diabetes and prediabetes were defined using the WHO criteria. The HbA1c cutoff points were evaluated to predict the future risks of diabetes. Relative risk (RR) was calculated using the chi-square test. The area under the receiver operating characteristic (ROC) curve (AUC) was used to evaluate the predictive efficiency of fasting plasma glucose (FPG), 2 hr postprandial plasma glucose (2hPG), and HbA1c for progression to diabetes. A superior cutoff point was defined as the point on the ROC curve with a larger Youden index. Results. Overall, 7.5% (210/2778) of the subjects progressed to diabetes, yielding an annual 2.5% diabetes incidence rate. Additionally, 4.5% (100/2227) of the subjects with normal glucose tolerance (NGT) and 19.6% (110/561) of the subjects with prediabetes progressed to diabetes, and the relative risk of progression to diabetes was 5.188 times higher in subjects with prediabetes than in subjects with NGT (p<0.001). Compared to subjects with HbA1c values ≤ 5.6%, the RRs of progression to diabetes in subjects whose HbA1c ranged from 5.7 to 5.8%, 5.9 to 6.2%, 6.3 to 6.4%, and ≥6.5% were 1.165, 2.582, 5.732, and 16.619, respectively. However, the RRs for subjects with HbA1c ranging from 5.7 to 5.8% and those with HbA1c ≤ 5.6% did not differ significantly (p=0.615). The AUCs for predicting diabetes after 3 years by FPG, 2hPG, and HbA1c were 0.752 (95% confidence interval 0.718–0.787), 0.710 (95% confidence interval 0.671–0.748), and 0.756 (95% confidence interval 0.720–0.793), respectively. The HbA1c cutoff point of 5.9% (sensitivity of 0.771 and specificity of 0.580) may better identify individuals at high risk of progression to diabetes than the 5.7% value (sensitivity of 0.862 and specificity of 0.371) due to the former’s larger Youden index of 0.351, which exceeded the indices for FPG and 2hPG. Conclusions. The use of HbA1c values ≥ 5.9% may provide greater accuracy in evaluating the risk of progression to diabetes and identify individuals with prediabetes with greater reliability among Chinese adults.
Databáze: OpenAIRE
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