J Korean Med Sci.  2012 Sep;27(9):1057-1061. 10.3346/jkms.2012.27.9.1057.

Usefulness of Glycated Hemoglobin as Diagnostic Criteria for Metabolic Syndrome

• Park SH
• Yoon JS
• Won KC
• Lee HW

• KMID: 1782139
• DOI: http://doi.org/10.3346/jkms.2012.27.9.1057

Abstract

The metabolic syndrome (MetS) is the clustering of cardiovascular risk factors and known as a powerful predictor of diabetes and cardiovascular disease. Glycated hemoglobin (HbA1c) is used as one of the diagnostic criteria for diabetes and category of increased risk for diabetes. We examined the usefulness of HbA1c as a diagnostic tool for MetS and to determine the cut-off value of HbA1c as a criterion for MetS, in non-diabetic Korean subjects. We analyzed 7,307 participants (male: 4,181, 57%) in a medical check-up program, and applied the newly recommended guidelines of the International Diabetes Federation for diagnosis of MetS. The mean HbA1c was 5.54% in all subjects and showed no significant difference between genders. Using receiver-operating characteristic curve, HbA1c value corresponding to the fasting plasma glucose value of 100 mg/dL was 5.65% (sensitivity 52.3%, specificity 76.7%). The prevalence of MetS was 8.5% according to the IDF guideline and 10.9% according to HbA1c value of 5.7%, showing 69.5% agreement rate. The detection rate of MetS increased to 25.7% using the HbA1c criterion of 5.7% instead of fasting hyperglycemia. This study suggests that HbA1c might be used as a diagnostic criterion for MetS and the appropriate cut-off value of HbA1c may be 5.65% in this Korean population.

Keyword

Metabolic Syndrome; Fasting Hyperglycemia; HbA1c

MeSH Terms

Adult
Blood Glucose/analysis
Chromatography, High Pressure Liquid
Female
Hemoglobin A, Glycosylated/*analysis
Humans
Male
Metabolic Syndrome X/*diagnosis/epidemiology
Middle Aged
Prevalence
ROC Curve
Risk Factors
Blood Glucose
Hemoglobin A, Glycosylated

Figure

• 

  Fig. 1 Prevalence of metabolic syndrome in total subjects, male and female according to modified IDF criteria.

Reference

1. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, Krauss RM, Savage PJ, Smith SC Jr, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute scientific statement. Circulation. 2005. 112:2735–2752.

2. Stern MP. Diabetes and cardiovascular disease: the common soil hypothesis. Diabetes. 1995. 44:369–381.

3. DeFronzo RA, Ferrannini E. Insulin resistance: a multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidemia, and atherosclerotic cardiovascular disease. Diabetes Care. 1991. 14:173–194.

4. Yoon SE, Ahn SG, Kim JY, Park JS, Shin JH, Tahk SJ, Lee SK, Kim TJ, Han N. Differential relationship between metabolic syndrome score and severity of coronary atherosclerosis as assessed by angiography in a non-diabetic and diabetic Korean population. J Korean Med Sci. 2011. 26:900–905.

5. Magliano DJ, Shaw JE, Zimmet PZ. How to best define the metabolic syndrome. Ann Med. 2006. 38:34–41.

6. Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, Fruchart JC, James WP, Loria CM, Smith SC Jr, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009. 120:1640–1645.

7. Kim DJ, Cho NH, Noh JH, Kim HJ, Choi YH, Jung JH, Min YK, Lee MS, Lee MK, Kim KW. Fasting plasma glucose cutoff value for the prediction of future diabetes development: a study of middle-aged Koreans in a health promotion center. J Korean Med Sci. 2005. 20:562–565.

8. American Diabetes Association. Standards of medical care in diabetes:2010. Diabetes Care. 2010. 33:S11–S61.

9. Kim HK, Bae SJ, Choe JO. Impact of HbA1c criterion on the detection of subjects with increased risk for diabetes among health check-up recipients in Korea. Diabetes Metab J. 2012. 36:151–156.

10. Rohlfing CL, Little RR, Wiedmeyer HM, England JD, Madsen R, Harris MI, Flagel KM, Ebberhardt MS, Goldstein DE. Use of GHb (HbA1c) in screening of undiagnosed diabetes in the US population. Diabetes Care. 2000. 23:187–191.

11. Inoue K, Matsumoto M, Akimoto K. Fasting plasma glucose and HbA1c as risk factors for type 2 diabetes. Diabet Med. 2008. 25:1157–1163.

12. Stratton IM, Adler AI, Neil AW, Turner R. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ. 2000. 321:405–412.

13. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications on insulin-dependent diabetes mellitus. N Engl J Med. 1993. 329:977–986.

14. Selvin E, Steffes MW, Zhu H, Matsushita K, Wagenknecht L, Pankow J, Coresh J, Brancati FL. Glycated hemoglobin, diabetes, and cardiovascular risk in nondiabetic adults. N Engl J Med. 2010. 362:800–811.

15. Park S, Barrett-Connor E, Wingard DL, Shan J, Edelstein S. GHb is a better predictor of cardiovascular disease than fasting or postchallenge plasma glucose in women without diabetes: the Rancho Bernardo Study. Diabetes Care. 1996. 19:450–456.

16. de Vegt F, Dekker JM, Ruhé HG, Stehouwer CD, Nijpels G, Bouter LM, Heine RJ. Hyperglycaemia is associated with all-cause and cardiovascular mortality in the Hoorn population: the Hoorn Study. Diabetologia. 1999. 42:926–931.

17. Osei K, Rhinesmith S, Gaillard T, Schuster D. 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. 2003. 88:4596–4601.

18. Ong KL, Tso AW, Lam KS, Cherny SS, Sham PC, Cheung BM. Using glycosylated hemoglobin to define the metabolic syndrome in United States adults. Diabetes Care. 2010. 33:1856–1858.

19. Lorenzo C, Wagenknecht LE, Hanley AJ, Rewers MJ, Karter AJ, Haffner SM. 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 (IRAS). Diabetes Care. 2010. 33:2104–2109.

20. Alberti KG, Zimmet P, Shaw J. IDF Epidemiology Task Force Consensus Group. The metabolic syndrome-a new worldwide definition. Lancet. 2005. 366:1059–1062.

21. Mitka M. Hemoglobin A1c poised to become preferred test for diagnosing diabetes. JAMA. 2009. 301:1528.

22. Little RR, Sacks DB. HbA1c: how do we measure it and what does it mean? Curr Opin Endocrinol Diabetes Obes. 2009. 16:113–118.

23. Cavalot F, Petrelli A, Traversa M, Bonomo K, Fiora E, Conti M, Anfossi G, Costa G, Trovati M. Postprandial blood glucose is a stronger predictor of cardiovascular events than fasting blood glucose in type 2 diabetes mellitus, particularly in women: lessons from the San Luigi Gonzaga Diabetes Study. J Clin Endocrinol Metab. 2006. 91:813–819.

24. Monnier L, Lapinski H, Colette C. Contributions of fasting and postprandial plasma glucose increments to the overall diurnal hyperglycemia of type 2 diabetic patients: variations with increasing levels of HbA(1c). Diabetes Care. 2003. 26:881–885.

25. Sung KC, Rhee EJ. Glycated haemoglobin as a predictor for metabolic syndrome in non diabetic Korean adults. Diabet Med. 2007. 24:848–854.

26. Kim JH, Choi SR, Lee JR, Shin JH, Lee SJ, Han MA, Park J, Bae HY, Kim SY. Association of hemoglobin A1c with cardiovascular disease risk factors and metabolic syndrome in nondiabetic adults. Korean Diabetes J. 2008. 32:435–444.