The Utility of HbA1c as a Diagnostic Criterion of Diabetes
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
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 defi ned as according to 2003ADA 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 specifi city 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%; specifi city, 88.2%; area under the curve, 0.85). HbA1c was signifi cantly 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 cutoff value for HbA1c was 6.45%, which was similar to the recommended diagnostic criterion of HbA1c by the 2009 ADA.
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 defi ned as according to 2003ADA 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 specifi city 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%; specifi city, 88.2%; area under the curve, 0.85). HbA1c was signifi cantly 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 cutoff value for HbA1c was 6.45%, which was similar to the recommended diagnostic criterion of HbA1c by the 2009 ADA.
참고문헌 (29)
- Harris MI, "Onset of NIDDM occurs at least 4-7 yr before clinical diagnosis", Diabetes Care, 15, pp.815~819 (1992)
- Ballard DJ, "Epidemiology of persistent proteinuria in type II diabetes mellitus. Population-based study in Rochester, Minnesota", Diabetes, 37, pp.405~412 (1988)
- Klein R, "The Wisconsin epidemiologic study of diabetic retinopathy. III. Prevalence and risk of diabetic retinopathy when age at diagnosis is 30 or more years", Arch Ophthalmol, 102, pp.527~532 (1984)
- UK Prospective Diabetes Study (UKPDS) Group, "Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33)", Lancet, 352, pp.837~853 (1998)
- Genuth S, "Follow-up report on the diagnosis of diabetes mellitus", Diabetes Care, 26, pp.3160~3167 (2003)
- Cox ME, "Tests for screening and diagnosis of type 2 diabetes", Clin Diabetes, 27, pp.132~138 (2009)
- International Expert Committee, "International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes", Diabetes Care, 32, pp.1327~1334 (2009)
- McCance DR, "Comparison of tests for glycated haemoglobin and fasting and two hour plasma glucose concentrations as diagnostic methods for diabetes", BMJ, 308, pp.1323~1328 (1994)
- Selvin E, "Meta-analysis: glycosylated hemoglobin and cardiovascular disease in diabetes mellitus", Ann Intern Med, 141, pp.421~431 (2004)
- The Diabetes Control and Complications Trial Research Group, "The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus", N Engl J Med, 329, pp.977~986 (1993)
- Lorenzo C, "Performance characteristics of the new definition of diabetes: the insulin resistance atherosclerosis study", Diabetes Care, 33, pp.335~337 (2010)
- Selvin E, "Elevated A1C in adults without a history of diabetes in the U.S", Diabetes Care, 32, pp.828~833 (2009)
- American Diabetes Association, "Diagnosis and classifi cation of diabetes mellitus", Diabetes Care, 34(1), pp.S62~S69 (2011)
- Matthews DR, "Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man", Diabetologia, 28, pp.412~419 (1985)
- Cowie CC, "Prevalence of diabetes and high risk for diabetes using A1C criteria in the U.S. population in 1988-2006", Diabetes Care, 33, pp.562~568 (2010)
- Zhou X, "Performance of an A1C and fasting capillary blood glucose test for screening newly diagnosed diabetes and pre-diabetes defi ned by an oral glucose tolerance test in Qingdao, China", Diabetes Care, 33, pp.545~550 (2010)
- Kramer CK, "A1C and diabetes diagnosis: The Rancho Bernardo Study", Diabetes Care, 33, pp.101~103 (2010)
- Buell C, "Utility of A1C for diabetes screening in the 1999 2004 NHANES population", Diabetes Care, 30, pp.2233~2235 (2007)
- 배지철, "서울의 한 대학병원에서 당뇨병을 예측하는 당화혈색소 값의 분석", Diabetes and Metabolism Journal, 33(6), pp.503~510 (2009), 대한당뇨병학회
- Rohlfing CL, "Use of GHb (HbA1c) in screening for undiagnosed diabetes in the U.S. population", Diabetes Care, 23, pp.187~191 (2000)
- Colagiuri S, "AusDiab. Screening for type 2 diabetes and impaired glucose metabolism: the Australian experience", Diabetes Care, 27, pp.367~371 (2004)
- 이찬희, "한국 성인에서 제2형 당뇨병의 예측인자로서 공복 혈장 혈당과 당화혈색소의 조합", Diabetes and Metabolism Journal, 33(4), pp.306~314 (2009), 대한당뇨병학회
- Kim KS, "Diagnostic value of glycated haemoglobin HbA(1c) for the early detection of diabetes in high-risk subjects", Diabet Med, 25, pp.997~1000 (2008)
- Carson AP, "Comparison of A1C and fasting glucose criteria to diagnose diabetes among U.S. adults", Diabetes Care, 33, pp.95~97 (2010)
- Osei K, "Is glycosylated hemoglobin A1c a surrogate for metabolic syndrome in nondiabetic, first-degree relatives of African-American patients with type 2 diabetes", J Clin Endocrinol Metab, 88, pp.4596~4601 (2003)
- de Vegt F, "Hyperglycaemia is associated with all-cause and cardiovascular mortality in the Hoorn population: the Hoorn Study", Diabetologia, 42, pp.926~931 (1999)
- Lorenzo C, "A1C between 5.7 and 6.4% as a marker for identifying pre-diabetes, insulin sensitivity and secretion, and cardiovascular risk factors: the Insulin Resistance Atherosclerosis Study (IRA S)", Diabetes Care, 33, pp.2104~2109 (2010)
- Dilley J, "Association of A1C with cardiovascular disease and metabolic syndrome in Asian Indians with normal glucose tolerance", Diabetes Care, 30, pp.1527~1532 (2007)