Korean J Fam Med.  2011 Nov;32(7):383-389. 10.4082/kjfm.2011.32.7.383.

The Utility of HbA1c as a Diagnostic Criterion of Diabetes

Affiliations
  • 1Department of Family Medicine, Dankook University College of Medicine, Cheonan, Korea. choiey@dku.edu

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 defined as according to 2003 ADA 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 specificity 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%; specificity, 88.2%; area under the curve, 0.85). HbA1c was significantly 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 cut-off value for HbA1c was 6.45%, which was similar to the recommended diagnostic criterion of HbA1c by the 2009 ADA.

Keyword

Diabetes; Hemoglobin A, Glycosylated; Diagnosis; Glucose Tolerance Test

MeSH Terms

Fasting
Glucose
Glucose Tolerance Test
Hemoglobin A, Glycosylated
Hemoglobins
Homeostasis
Humans
Insulin Resistance
Plasma
Prevalence
ROC Curve
Sensitivity and Specificity
Glucose
Hemoglobin A, Glycosylated
Hemoglobins
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