Prediction of Type 2 Diabetes by Hemoglobin A1c in Two Community-Based Cohorts
- 1 January 2018
- journal article
- Published by American Diabetes Association
Abstract
OBJECTIVEHemoglobin A(1c) (HbA(1c)) can be used to assess type 2 diabetes (T2D) risk. We asked whether HbA(1c) was associated with T2D risk in four scenarios of clinical information availability: 1) HbA(1c) alone, 2) fasting laboratory tests, 3) clinic data, and 4) fasting laboratory tests and clinic data.RESEARCH DESIGN AND METHODSWe studied a prospective cohort of white (N = 11,244) and black (N = 2,294) middle-aged participants without diabetes in the Framingham Heart Study and Atherosclerosis Risk in Communities study. Association of HbA(1c) with incident T2D (defined by medication use or fasting glucose [FG] 126 mg/dL) was evaluated in regression models adjusted for 1) age and sex (demographics); 2) demographics, FG, HDL, and triglycerides; 3) demographics, BMI, blood pressure, and T2D family history; or 4) all preceding covariates. We combined results from cohort and race analyses by random-effects meta-analyses. Subsidiary analyses tested the association of HbA(1c) with developing T2D within 8 years or only after 8 years.RESULTSOver 20 years, 3,315 individuals developed T2D. With adjustment for demographics, the odds of T2D increased fourfold for each percentage-unit increase in HbA(1c). The odds ratio (OR) was 4.00 (95% CI 3.14, 5.10) for blacks and 4.73 (3.10, 7.21) for whites, resulting in a combined OR of 4.50 (3.35, 6.03). After adjustment for fasting laboratory tests and clinic data, the combined OR was 2.68 (2.15, 3.34) over 20 years, 5.79 (2.51, 13.36) within 8 years, and 2.23 (1.94, 2.57) after 8 years.CONCLUSIONSHbA(1c) predicts T2D in different common scenarios and is useful for identifying individuals with elevated T2D risk in both the short- and long-term.Funding Information
- Quest Diagnostics, Inc.
This publication has 52 references indexed in Scilit:
- Common Hb-variants show no longer interference on the Tosoh G8 after an update of the softwareClinica Chimica Acta; International Journal of Clinical Chemistry, 2016
- Definition, Classification and Diagnosis of Diabetes, Prediabetes and Metabolic SyndromeCanadian Journal of Diabetes, 2013
- Development of a new scoring system for predicting the 5 year incidence of type 2 diabetes in Japan: the Toranomon Hospital Health Management Center Study 6 (TOPICS 6)Diabetologia, 2012
- Prognostic value of haemoglobin A1c and fasting plasma glucose for incident diabetes and implications for screeningEuropean Journal of Epidemiology, 2011
- Optimal range of HbA1c for the prediction of future diabetes: A 4-year longitudinal studyDiabetes Research and Clinical Practice, 2011
- HbA1c in the prediction of type 2 diabetes compared with fasting and 2-h post-challenge plasma glucose: The Asturias study (1998–2005)Diabetes & Metabolism, 2011
- Identifying Adults at High Risk for Diabetes and Cardiovascular Disease Using Hemoglobin A1c: National Health and Nutrition Examination Survey 2005–2006American Journal of Preventive Medicine, 2011
- Is the measurement of glycated hemoglobin A1c alone an efficient screening test for undiagnosed diabetes?: Japan National Diabetes SurveyDiabetes Research and Clinical Practice, 2007
- Lack of excess maternal transmission of type 2 diabetes in a Korean populationDiabetes Research and Clinical Practice, 2004
- Quantifying heterogeneity in a meta-analysisStatistics in Medicine, 2002