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Hba1c Cut Off For Prediabetes

Hba1c Screening Fails To Identify Many Patients With Diabetes And Prediabetes

Hba1c Screening Fails To Identify Many Patients With Diabetes And Prediabetes

San Diego, CA—Screening for diabetes and prediabetes in primary care using hemoglobin (Hb)A1c misclassified a substantial percentage of patients, whereas oral glucose tolerance testing (OGTT) was more accurate, according to a large study of veterans at risk for diabetes. HbA1c screeningfailed to diagnose 10% of patients with diabetes and 42% of patients with prediabetes who were correctly identified by OGTT. “There is a clear need for screening of high-risk individuals. In this study, HbA1c misclassified a larger percentage of patients, missing the disease when present and classifying patients as normal when they had diabetes,” stated Sandra L. Jackson, MD, Research Fellow at Emory University, Atlanta, GA, at the 2011 Scientific Sessions of the American Diabetes Association (ADA). The study was based on a sample of 789 veterans who were part of a screening study with a planned enrollment of 1800 veterans. “Veterans are at risk for diabetes, because there are more minorities and older people in this group,” Dr Jackson pointed out. All enrollees were considered at high risk for diabetes, because of age, weight, or other risk factors. Of them, 95% were men, 73.9% were black, 51% were obese, 40% were overweight, and 9% were normal weight. The mean age was 57.5 years. OGTT has some drawbacks, including the requirement for fasting, morning testing, and imposing a burden on the healthcare system, because it takes 2 hours to administer. Furthermore, reproducibility is poor. HbA1c screening is more convenient and has less day-to-day variation, but it can be unreliable, and there is lack of agreement on cutoffs. Also, black people and older people may have higher HbA1c at baseline. All participants were screened using OGTT and HbA1c. In accordance with criteria from the Continue reading >>

Diagnosis

Diagnosis

Print The American Diabetes Association (ADA) recommends that blood glucose screening for adults begin at age 45, or sooner if you are overweight and have additional risk factors for prediabetes or type 2 diabetes. There are several blood tests for prediabetes. Glycated hemoglobin (A1C) test This test indicates your average blood sugar level for the past two to three months. Specifically, the test measures the percentage of blood sugar attached to the oxygen-carrying protein in red blood cells (hemoglobin). The higher your blood sugar levels, the more hemoglobin you'll have with sugar attached. In general: An A1C level below 5.7 percent is considered normal An A1C level between 5.7 and 6.4 percent is considered prediabetes An A1C level of 6.5 percent or higher on two separate tests indicates type 2 diabetes Certain conditions can make the A1C test inaccurate — such as if you are pregnant or have an uncommon form of hemoglobin (hemoglobin variant). Fasting blood sugar test A blood sample is taken after you fast for at least eight hours or overnight. In general: A fasting blood sugar level below 100 milligrams per deciliter (mg/dL) — 5.6 millimoles per liter (mmol/L) — is considered normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 7.0 mmol/L) is considered prediabetes. This result is sometimes called impaired fasting glucose. A fasting blood sugar level of 126 mg/dL (7.0 mmol/L) or higher indicates type 2 diabetes. Oral glucose tolerance test This test is usually used to diagnose diabetes only during pregnancy. A blood sample is taken after you fast for at least eight hours or overnight. Then you'll drink a sugary solution, and your blood sugar level will be measured again after two hours. In general: A blood sugar level less than 140 mg/dL (7.8 mmo Continue reading >>

How Do You Know If You Have Diabetes Or Pre-diabetes?

How Do You Know If You Have Diabetes Or Pre-diabetes?

"How Do You Know If You Have Diabetes or Pre-Diabetes?" is an important question given the current epidemic of adult-onset diabetes. The short answer is - ask your doctor who will order a test. However, as we shall see, it is far from that simple. Another short answer is that it simply a matter of a definition, and that there are more than one. Diabetes is a metabolic disease characterized by abnormally elevated levels of blood glucose (hyperglycemia) resulting from defects in insulin secretion, insulin action or both. Chronic hyperglycaemia of diabetes in associated with the dysfunction, long-term damage and failure of various organs and systems, especially the kidneys, eyes, nerves, heart and blood vessels. These long-term complications include retinopathy with potential loss of vision, nephropathy leading to kidney failure, peripheral neuropathy with risk of foot ulcers, amputations, and neuropathy of the autonomic nervous system resulting in gastrointestinal, genitourinary and cardiovascular symptoms and sexual dysfunction. Thus diagnosing diabetes or pre-diabetes and then attempting to reverse the associated hyperglycemia or at least minimize the micro- and macrovascular damage is an important and significant challenge with profound public health implications. The vast majority of cases of diabetics are so-called Type 2, which historically was termed adult-onset diabetes and is caused by a combination of resistance to the action of insulin and an inadequate compensatory insulin secretory response. Type 1 diabetes, on the other hand, is caused by an absolute deficiency of insulin secretion, frequently occurs at a young age and requires generally requires life-long insulin injections. In Type 2 diabetes the degree of hyperglycemia sufficient to cause pathologic and f Continue reading >>

New Cut-off Point Recommended For Diagnosing Prediabetes

New Cut-off Point Recommended For Diagnosing Prediabetes

A new study in the BMJ reports that the cut-off scores for defining whether someone has prediabetes needs revising. Prediabetes, a term that is often used interchangeably with metabolic syndrome, exists when a person is diagnosed with high blood sugar levels near-characteristic of type 2 diabetes. Someone who is diagnosed with prediabetes will also usually have higher than normal blood sugar levels after eating, and/or raised HbA1c levels. The cut-off points at which a person’s blood sugar is considered abnormal vary across guidelines and countries. This study suggests that health risks associated with prediabetes seem to increase at the lower cut-off point for blood sugar levels recommended by some guidelines. The World Health Organisation (WHO) defines prediabetes as fasting glucose levels of 6.1 to 6.9 mmol/L, while NICE considers abnormal anything above 7.0 mmol/L. After conducting a meta-analysis of 53 studies, involving over 1.6 million individuals, researchers from Southern Medical University in China found that risk assessment for prediabetes should be reviewed. They found that the increased risk of cardiovascular disease and all-cause mortality from prediabetes tend to be higher in people with fasting blood sugar levels as low as 5.6 mmol/L. This corresponds to the American Diabetes Association (ADA)’s lower cut-off point for impaired fasting blood sugar levels. Aside from having blood sugar levels regularly tested, the most effective preventative tools in our arsenal against prediabetes remain eating a balanced diet and exercising often. The new findings highlight that the problem of labelling people as having prediabetes is that these categories are unstable and the risk progression from pre-diabetes to type 2 diabetes differs between populations. This co Continue reading >>

Prediabetes (borderline Diabetes)

Prediabetes (borderline Diabetes)

Tweet Prediabetes, also commonly referred to as borderline diabetes, is a metabolic condition and growing global problem that is closely tied to obesity. If undiagnosed or untreated, prediabetes can develop into type 2 diabetes; which whilst treatable is currently not fully reversible. What is prediabetes? Prediabetes is characterised by the presence of blood glucose levels that are higher than normal but not yet high enough to be classed as diabetes. For this reason, prediabetes is often described as the “gray area” between normal blood sugar and diabetic levels. In the UK, around 7 million people are estimated to have prediabetes and thus have a high risk for developing type 2 diabetes. [17] Prediabetes may be referred to as impaired fasting glucose (IFT), if you have higher than normal sugar levels after a period of fasting, or as impaired glucose tolerance (IGT), if you have higher than normal sugar levels following eating. The increasing number of new cases of prediabetes presents a global concern as it carries large scale implications towards the future burden on healthcare. Between 2003 and 2011, the prevalence of prediabetes in England alone more than tripled, with 35.3% of the adult population, or 1 in every 3 people having prediabetes. [106] Learn more about prediabetes Prediabetes is a critical stage in the development of diabetes, for it is at this point that lifestyle choices can be made to turn it around. Early, decisive action can slow down or even halt the development of type 2 diabetes. What are the symptoms of prediabetes? Many people have prediabetes but are completely unaware of it. This is because the condition often develops gradually without any warning signs or symptoms. In many cases, the sufferer only learns of their borderline diabetic sta Continue reading >>

New Cut-off Point Recommended For Diagnosing Prediabetes

New Cut-off Point Recommended For Diagnosing Prediabetes

A new in the BMJ reports that the cut-off scores for defining whether someone has needs revising. Prediabetes, a term that is often used interchangeably with metabolic syndrome, exists when a person is diagnosed with high near-characteristic of type 2 diabetes. Someone who is diagnosed with will also usually have higher than normal blood sugar levels after eating, and/or raised . The cut-off points at which a person's blood sugar is considered abnormal vary across guidelines and countries. This study suggests that health risks associated with prediabetes seem to increase at the lower cut-off point for blood sugar levels recommended by some guidelines. The (WHO) defines prediabetes as fasting glucose levels of 6.1 to 6.9 mmol/L, while . After conducting a meta-analysis of 53 studies, involving over 1.6 million individuals, researchers from Southern Medical University in China found that risk assessment for prediabetes should be reviewed. They found that the increased risk of and all-cause mortality from prediabetes tend to be higher in people with fasting blood sugar levels as low as 5.6 mmol/L. This corresponds to the American Diabetes Association (ADA)'s lower cut-off point for impaired fasting blood sugar levels. Aside from having blood sugar levels regularly tested, the most effective preventative tools in our arsenal against prediabetes remain eating a and exercising often. The new findings highlight that the problem of labelling people as having prediabetes is that these categories are unstable and the risk progression from pre-diabetes to differs between populations. This could therefore have implications for the classification and prevention of prediabetes in the UK. Tweet Type 2 diabetes mellitus is a metabolic disorder that results in hyperglycemia (high blood Continue reading >>

Do I Have Prediabetes Or Diabetes? Guide To The A1c, Fpg, And Ogtt Tests, Plus Tips For Prevention

Do I Have Prediabetes Or Diabetes? Guide To The A1c, Fpg, And Ogtt Tests, Plus Tips For Prevention

If you’ve been diagnosed with prediabetes, you may wonder what that means. It’s a condition where your blood glucose levels are above normal, but not high enough for you to be diagnosed with diabetes. Many doctors consider prediabetes to be the first stage of type 2 diabetes. Studies show that 15 to 30 percent of people with prediabetes will develop diabetes in as little as five years without intervention, such as weight loss or increased physical activity. In fact, most people who get type 2 diabetes had prediabetes first. Prediabetes is serious in and of itself. People with this condition have a greater risk of developing cardiovascular disease than those without it. There are three tests that doctors can do in order to determine whether you have high blood sugar. A1C This blood test, which is also called hemoglobin A1c, HbA1c, or glycosylated hemoglobin, measures the percentage of sugar that is attached to your hemoglobin. Hemoglobin is a protein in your red blood cells. The higher the A1C, the higher your average blood sugar levels have been running over the past two or three months. A normal A1C is below 5.7 percent. An A1C between 5.7 percent and 6.4 percent suggests prediabetes. An A1C of 6.5 or more indicates type 2 diabetes if the test is confirmed. If your results are questionable, your doctor will retest your A1C on another day to confirm the diagnosis. Fasting plasma glucose The fasting plasma glucose (FPG) test is a blood test that’s done after you’ve been fasting overnight. It measures the sugar in your blood. A normal fasting glucose test is lower than 100 milligrams per deciliter (mg/dL). A result between 100 and 125 mg/dL is diagnostic for prediabetes. One that is 126 mg/dL or above is indicative of diabetes. It’s recommended to retest this an Continue reading >>

Increased Hemoglobin A1c Threshold For Prediabetes Remarkably Improving The Agreement Between A1c And Oral Glucose Tolerance Test Criteria In Obese Population

Increased Hemoglobin A1c Threshold For Prediabetes Remarkably Improving The Agreement Between A1c And Oral Glucose Tolerance Test Criteria In Obese Population

It is unclear why the prevalence of diabetes and prediabetes, especially prediabetes, between diagnosed by oral glucose tolerance test (OGTT) and hemoglobin A1c (HbA1c) criteria, is substantially discordant. We aimed to evaluate the effects of obesity on the agreement between HbA1c and OGTT for diagnosing diabetes and prediabetes and identify the optimal HbA1c cutoff values in different body mass index (BMI) classifications. The agreement between HbA1c criteria and OGTT decreased with BMI gain (κ = 0.359, 0.312, and 0.275 in a normal weight, overweight, and obese population, respectively). The structural equational model results showed that BMI was significantly associated with HbA1c in normal glucose tolerance and prediabetes subjects but not in diabetes subjects. At a specificity of 80% for prediabetes and 97.5% for diabetes, the optimal HbA1c cutoff points for prediabetes and diabetes were 5.6% and 6.4% in normal-weight, 5.7% and 6.5% in overweight, and 6.0% and 6.5% in an obese population. When the new HbA1c cutoff values were used, the agreement in obese subjects increased almost to the level in normal-weight subjects. The objective of our study was to investigate the effects of in vitro glycoxidized HDL and HDL from patients with T2D on platelet aggregation and arachidonic acid signaling cascade. At the same time, the contents of hydroxylated fatty acids were assessed in HDL. Compared with control HDL, in vitro glycoxidized HDL had decreased proportions of linoleic (LA) and arachidonic (AA) acids in phospholipids and cholesteryl esters, and increased concentrations of hydroxy-octadecadienoic acids (9-HODE and 13-HODE) and 15-hydroxy-eicosatetraenoic acid (15-HETE), derived from LA and AA respectively, especially hydroxy derivatives esterified in phospholipids. Gl Continue reading >>

Evaluation Of Glycated Hemoglobin (hba1c) For Diagnosing Type 2 Diabetes And Prediabetes Among Palestinian Arab Population

Evaluation Of Glycated Hemoglobin (hba1c) For Diagnosing Type 2 Diabetes And Prediabetes Among Palestinian Arab Population

Abstract The purpose of the study is to compare the potential of HbA1c to diagnose diabetes among Palestinian Arabs compared to fasting plasma glucose (FPG). A cross-sectional sample of 1370 Palestinian men (468) and women (902) without known diabetes and above the age of 30 years were recruited. Whole blood was used to estimate HbA1c and plasma for FPG and total lipid profile. Fasting plasma glucose was used as a reference to diagnose diabetes (≥ 126 mg/dL) and prediabetes (100–125 mg/dL). The area under the receiver operating characteristic curve (AUC) for HbA1c was 81.9% to diagnose diabetes and 63.9% for prediabetes. The agreement between HbA1c and diabetes as diagnosed by FPG was moderate (ĸ = 0.498) and low with prediabetes (ĸ = 0.142). The optimal cut-off value for HbA1c to diagnose diabetes was ≥ 6.3% (45 mmol/mol). The sensitivity, specificity and the discriminant ability were 65.6% (53.1–76.3%), 94.5% (93.1–95.6%), 80.0% (72.8–87.3%), respectively. However, using cut-off value of ≥ 6.5% (48 mmol/mol) improved specificity. At this cut-off value, the sensitivity, specificity and the discriminant ability were 57.4% (44.9–69.0%), 97.1% (96.0–97.9%) and 77.3% (71.0–83.5%). For diagnosing prediabetes with HbA1c between 5.7–6.4% (39–46 mmol/mol), the sensitivity, specificity and the discriminant ability were 62.7% (57.1–67.9%), 56.3% (53.1–59.4%) and 59.5% (56.3–62.5%), respectively. HbA1c at cut-off value of ≥ 6.5% (48 mmol/mol) by itself diagnosed 5.3% and 48.3% as having diabetes and prediabetes compared to 4.5% and 24.2% using FPG, respectively. Mean HbA1c and FPG increase significantly with increasing body mass index. In conclusion, the ROC curves showed HbA1c could be used for diagnosing diabetes when compared to FPG but not fo Continue reading >>

Children At High Risk Of Diabetes Should Be Screened By Hba1c And Oral Glucose Tolerance Tests

Children At High Risk Of Diabetes Should Be Screened By Hba1c And Oral Glucose Tolerance Tests

Contact: Aaron Lohr Chief Communications Officer Phone: 202.971.3654 [email protected] Contact: Jenni Glenn Gingery Associate Director, Communications and Media Relations Phone: 202.971.3655 [email protected] ORLANDO - Doctors should add an oral glucose tolerance test (OGTT) to their hemoglobin A1C (HbA1C) when they screen high-risk children for prediabetes and diabetes, new research from South Korea suggests. The study results will be presented Tuesday, April 4, at ENDO 2017, the annual scientific meeting of the Endocrine Society, in Orlando, Fla. "We recommend the combined use of fasting and 2-hour glucose levels, in addition to HbA1C, for the diagnosis of childhood prediabetes and diabetes," said the first author Hyo-Kyoung Nam, M.D., Ph.D., clinical assistant professor of pediatrics at the Korea University College of Medicine in Seoul, South Korea. "Traditionally, plasma glucose levels obtained from oral glucose tolerance tests have been used to diagnose prediabetes and diabetes. Hemoglobin A1C, which is easy to use and does not require fasting, has recently been recommended as an alternative diagnostic method in adults. However, using HbA1C to diagnose prediabetes and diabetes in children and adolescents is controversial," Nam added. The research team evaluated the ability of HbA1C to diagnose prediabetes and diabetes and they established the optimal HbA1C cutoff points for detecting prediabetes and diabetes in youth. They reviewed the medical records of 217 obese boys and 172 obese girls who had undergone OGTT and HbA1C testing simultaneously between January 2010 and June 2016 in six University hospitals. The children were diagnosed with prediabetes (fasting glucose 5.6 to 6.9 mmol/L; 2-hour glucose 7.8 to 11.0 mmol/L) or with diabetes (fasting glucose 7.0 Continue reading >>

Identification Of Hba1c Cut-off For Pre-diabetes From Incidence Of Diabetes In A Japanese Population T. Yuki

Identification Of Hba1c Cut-off For Pre-diabetes From Incidence Of Diabetes In A Japanese Population T. Yuki

1, T. Nakagami1, J. Oya1, Y. Yamamoto1, Y. Hasegawa1, M. Kurita1, Y. Endo2, Y. Uchigata1; 1Diabetes Center, Tokyo Women's Medical University, Tokyo, 2Department of Health and Community Medicine, Saitama-ken Saiseikai Kurihashi Hospital, Saitama, Japan. Background and aims: Pre-diabetes is an intermediate stage between normal glucose and diabetes. It includes impaired fasting glucose on fasting plasma glucose (FPG) (110-125 mg/dL) and impaired glucose tolerance on 2-hour plasma glucose on a 75g oral glucose tolerance test (140-199 mg/dL). Individuals with pre-diabetes have a high risk of developing diabetes mellitus (DM). However, there is no clear cut-off point for HbA1c to define pre-diabetes. The aim of the study was to identify the cut-offs for HbA1c with respect to incidence of DM on HbA1c. Materials and methods: We registered participants who underwent general health check up at SSK hospital from February 2006 to January 2007 as baseline and followed them for five years until January 2012. 3,826 subjects who had FPG <126 mg/dl (mean follow-up period 4.0 ± 1.4y) and 2,772 subjects who had HbA1c <6.5% (mean follow-up period 4.0 ± 1.4y) were analyzed respectively. Diabetes was diagnosed if HbA1c ≥6.5% (HbA1c-DM) or FPG ≥126 mg/dl (FPG-DM) at least once during the follow- up period. We assessed the risk of developing diabetes according to different stage of glucose tolerance by survival analysis using the Cox proportional hazards model. Receiver operating characteristic (ROC) curve analysis was used to identify the optimal cut-off point for incidence of diabetes on FPG and HbA1c, respectively. Results: Of the 3,826 subjects with FPG<126mg/dL, 129 (3.4%) developed FPG-DM while of the 2,772 subjects with HbA1c<6.5%, 74 (2.7 %) developed HbA1c-DM. In the Continue reading >>

Get Unlimited Access On Medscape.

Get Unlimited Access On Medscape.

WARNING: RISK OF THYROID C-CELL TUMORS In rodents, semaglutide causes dose-dependent and treatment-duration-dependent thyroid C-cell tumors at clinically relevant exposures. It is unknown whether Ozempic® causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans as human relevance of semaglutide-induced rodent thyroid C-cell tumors has not been determined. Ozempic® is contraindicated in patients with a personal or family history of MTC and in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Counsel patients regarding the potential risk for MTC with the use of Ozempic® and inform them of symptoms of thyroid tumors (e.g. a mass in the neck, dysphagia, dyspnea, persistent hoarseness). Routine monitoring of serum calcitonin or using thyroid ultrasound is of uncertain value for early detection of MTC in patients treated with Ozempic®. Ozempic® is not recommended as a first-line therapy for patients who have inadequate glycemic control on diet and exercise because of the uncertain relevance of rodent C-cell tumor findings to humans. Ozempic® has not been studied in patients with a history of pancreatitis. Consider other antidiabetic therapies in patients with a history of pancreatitis. Ozempic® is not a substitute for insulin. Ozempic® is not indicated for use in patients with type 1 diabetes mellitus or for the treatment of patients with diabetic ketoacidosis. Pancreatitis: Acute and chronic pancreatitis have been reported in clinical studies. Observe patients carefully for signs and symptoms of pancreatitis (persistent severe abdominal pain, sometimes radiating to the back with or without vomiting). If pancreatitis is suspected, discontinue Ozempic® promptly and if pancreatitis is confirmed, do not restart. Diabetic Ret Continue reading >>

Type 2 Diabetes: Prevention In People At High Risk

Type 2 Diabetes: Prevention In People At High Risk

Behaviour change Evidence-based behaviour-change advice includes: helping people to understand the short, medium and longer-term consequences of health-related behaviour helping people to feel positive about the benefits of changing their behaviour building the person's confidence in their ability to make and sustain changes recognising how social contexts and relationships may affect a person's behaviour helping plan changes in terms of easy steps over time identifying and planning for situations that might undermine the changes people are trying to make (including planning explicit 'if–then' coping strategies to prevent relapse) encouraging people to make a personal commitment to adopt health-enhancing behaviours by setting (and recording) achievable goals in particular contexts, over a specified time helping people to use self-regulation techniques (such as self-monitoring, progress review, relapse management and goal revision) to encourage learning from experience encouraging people to engage the support of others to help them to achieve their behaviour-change goals. Brief advice Typically, for diabetes prevention, brief advice might consist of a 5–15 minute consultation. The aim is to help someone make an informed choice about whether to make lifestyle changes to reduce their risk of diabetes. The discussion covers what that might involve and why it would be beneficial. Practitioners may provide written information in a range of formats and languages about the benefits and, if the person is interested in making changes, may discuss how these can be achieved and sustained in the long term. Brief intervention Brief interventions for diabetes prevention can be delivered by GPs, nurses, healthcare assistants and professionals in primary healthcare and the community Continue reading >>

Prediabetes Cutoff Called Cost-effective

Prediabetes Cutoff Called Cost-effective

Using hemoglobin A1c (HbA1c) to catch prediabetes may be cost-effective if the threshold for diagnosis is set at 5.7%, according to an analysis led by the CDC. The cost of treating patients for an HbA1c level less than 5.7% would likely outweigh the savings from improvement in long-term outcomes, according to an analysis by Xiaohui Zhuo, PhD, of the CDC in Atlanta, and colleagues largely at the same agency. Those diagnostic cutoffs wouldn't fall within the $50,000 per quality life-year gained, typically considered cost-effective, they reported in the April issue of the American Journal of Preventive Medicine. "Lowering the cutoff from 5.7% to 5.6% also may be cost effective, however, if the costs of preventive interventions were to be lowered," the group noted. The threshold for diagnosing prediabetes became controversial in 2009, when the American Diabetes Association recommended using hemoglobin A1c as the new standard diagnostic test for diabetes and prediabetes. That organization indicated 6.5% as the cutoff for frank diabetes, but the level indicating prediabetes has variably been set anywhere from 6.0% to 5.5% by different professional groups. "Establishing an HbA1c cutoff for prediabetes, however, has been more challenging than for diabetes because the relationship between the incidence of type 2 diabetes and HbA1c below 6.5% is continuous, with no clearly demarcated threshold that is associated with an accelerated risk of diabetes or other morbidities," Zhou's group explained. They ran simulations using a nationally representative sample of the nondiabetic adult population in the National Health and Nutritional Examination Survey (NHANES 1999 to 2006), modeling the impact of each 0.1% increment in the threshold for prediabetes from 6.4% to 5.5%. Each lower thres Continue reading >>

Screening For Diabetes And Pre-diabetes With Proposed A1c-based Diagnostic Criteria

Screening For Diabetes And Pre-diabetes With Proposed A1c-based Diagnostic Criteria

OBJECTIVE An International Expert Committee (IEC) and the American Diabetes Association (ADA) proposed diagnostic criteria for diabetes and pre-diabetes based on A1C levels. We hypothesized that screening for diabetes and pre-diabetes with A1C measurements would differ from using oral glucose tolerance tests (OGTT). RESEARCH DESIGN AND METHODS We compared pre-diabetes, dysglycemia (diabetes or pre-diabetes), and diabetes identified by the proposed criteria (A1C ≥6.5% for diabetes and 6.0–6.4% [IEC] or 5.7–6.4% [ADA] for high risk/pre-diabetes) with standard OGTT diagnoses in three datasets. Non-Hispanic white or black adults without known diabetes who had A1C and 75-g OGTT measurements were included from the prospective Screening for Impaired Glucose Tolerance study (n = 1,581), and from the National Health and Nutrition Examination Survey (NHANES) III (n = 2014), and NHANES 2005–2006 (n = 1,111). RESULTS OGTTs revealed pre-diabetes in 35.8% and diabetes in 5.2% of combined study subjects. A1C provided receiver operating characteristic (ROC) curve areas for diabetes of 0.79–0.83, but ROC curve areas were ≤0.70 for dysglycemia or pre-diabetes. The proposed criteria missed 70% of individuals with diabetes, 71–84% with dysglycemia, and 82–94% with pre-diabetes. Compared with the IEC criteria, the ADA criteria for pre-diabetes resulted in fewer false-negative and more false-positive result. There were also racial differences, with false-positive results being more common in black subjects and false-negative results being more common in white subjects. With use of NHANES 2005–2006 data, ∼5.9 million non-Hispanic U.S. adults with unrecognized diabetes and 43–52 million with pre-diabetes would be missed by screening with A1C. CONCLUSIONS The proposed A1C Continue reading >>

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