Glycated hemoglobin for the diagnosis of diabetes and prediabetes: Diagnostic impact on obese and lean subjects, and phenotypic characterization

Journal of Diabetes Investigation

Michela Incani³  Federica Sentinelli¹  Laura Perra³  Maria Grazia Pani³  Marta Porcu³  Andrea Lenzi¹  Maria Gisella Cavallo²  Efisio Cossu³  Frida Leonetti¹ 

[1] Department of Experimental Medicine, Section of Endocrinology, Sapienza University of Rome, Rome, Italy;Department of Clinical and Medical Therapy, Unit of Atherosclerosis, Sapienza University of Rome, Rome, Italy;Department of Medical Sciences, Endocrinology and Diabetes, University of Cagliari, Cagliari, Italy

关键词: Glycated hemoglobin;    Obesity;    Type 2 diabetes;   

DOI  :  10.1111/jdi.12241

来源: Wiley

【 摘 要 】

Abstract

Aims/Introduction

Measurement of glycated hemoglobin (HbA1c) has been recommended for the diagnosis of diabetes and prediabetes. However, epidemiological studies have shown significant discordance between HbA1c and glucose-based tests. Of the factors that could influence agreement between HbA1c and the oral glucose tolerance test (OGTT), bodyweight has not been fully evaluated. The aims of the present study were to evaluate the impact of HbA1c criteria to diagnose diabetes and prediabetes compared with OGTT, and to examine HbA1c in relation to body mass index.

Materials and Methods

Two cohorts were studied, one from an obesity clinic (n = 592) and one from subjects undergoing screening for diabetes (n = 462). All underwent OGTT and HbA1c measurement.

Results

In the obese cohort, HbA1c ≥6.5% (≥48 mmol/mol) showed a sensitivity of 69.3% for diabetes, whereas HbA1c 5.7–6.4% (39–46 mmol/mol) did not identify prediabetes well (sensitivity 39.1%). In the diabetes screening cohort, HbA1c had low sensitivities for both diabetes (39.2%) and prediabetes (53.3%). When participants were stratified according to body mass index class I–III, HbA1c agreement with the OGTT for diabetes was much higher (80%, P < 0.005) in class I obesity compared with class II–III obesity; whereas for prediabetes, HbA1c had a low sensitivity in all obesity classes.

Conclusions

The agreement between HbA1c, fasting plasma glucose and 2-h glucose post-OGTT for the diagnosis of prediabetes was poor in our Italian population; whereas HbA1c ≥6.5% showed a relatively good agreement with OGTT for the diagnosis of diabetes. For the first time, we have shown that obesity class influences the diagnostic performance of HbA1c.

【 授权许可】

CC BY-NC-ND   
© 2014 The Authors. Journal of Diabetes Investigation published by Asian Association of the Study of Diabetes (AASD) and Wiley Publishing Asia Pty Ltd

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