Hemoglobin A1c testing alone does not sufficiently identify patients with prediabetes.
Sophie Bersoux1, Curtiss B Cook, Qing Wu
1Division of Community Internal Medicine, Mayo Clinic, Scottsdale, AZ 85259, USA.
American Journal of Clinical Pathology
|April 20, 2011
Summary
Hemoglobin A1c (HbA1c) testing alone may miss many individuals with prediabetes. Many patients with impaired glucose levels had HbA1c results below diagnostic thresholds, highlighting the need for comprehensive screening.
Area of Science:
- Endocrinology
- Metabolic Disorders
- Diabetes Mellitus Research
Background:
- The diagnostic utility of Hemoglobin A1c (HbA1c) for diabetes and prediabetes remains a subject of ongoing debate.
- Prediabetes affects a significant portion of the population, increasing the risk of developing type 2 diabetes.
Purpose of the Study:
- To evaluate the prevalence of elevated HbA1c levels within a prediabetes patient cohort.
- To determine the effectiveness of HbA1c testing in identifying individuals eligible for diabetes prevention programs.
Main Methods:
- Analysis of oral glucose tolerance tests (OGTT) and HbA1c levels in patients entering a diabetes prevention program.
- Calculation of the percentage of patients with impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) falling within specific HbA1c ranges (6.0%-6.4% and 5.7%-6.4%).
Main Results:
- The study included 242 patients (mean age 62 years, 64% women, 88% white).
- 56.2% of patients had isolated IFG, and 37.2% had combined IFG and IGT.
- Only 28.5% of patients had HbA1c values between 6.0% and 6.4%, while 65.3% had values between 5.7% and 6.4%.
Conclusions:
- Relying solely on HbA1c testing may fail to identify a substantial number of individuals with prediabetes who could benefit from intervention.
- Comprehensive diagnostic approaches, including OGTT, are crucial for accurate prediabetes identification and enrollment in prevention programs.
Related Concept Videos
01:25Type II Diabetes Mellitus III: Clinical Manifestations and Diagnosis
Type 2 diabetes mellitus develops gradually and is often asymptomatic in early stages.Clinical ManifestationsWhen symptoms appear, they include fatigue, blurred vision, pruritus, delayed wound healing, and recurrent infections, particularly candidal infections. Peripheral neuropathy may present as numbness or tingling in the extremities. Classic hyperglycemia symptoms—polyuria, polydipsia, and polyphagia—are less common. Most patients are overweight and frequently have associated hypertension...
01:29Hyperglycemia
Hyperglycemia is an abnormally high blood glucose level. It is diagnosed by fasting glucose ≥126 mg/dL, 2-hour oral glucose tolerance test (or OGTT) ≥200 mg/dL, random glucose ≥200 mg/dL with symptoms, or HbA1c ≥6.5%. However, HbA1c results may be unreliable in certain conditions, such as anemia or hemoglobinopathies, and the diagnosis should be confirmed unless classic symptoms are present. Postprandial hyperglycemia is typically considered significant when glucose levels exceed 180 mg/dL two...
01:22Diabetes Mellitus: Type 2 and Gestational
Type 2 diabetes, characterized by insulin resistance, arises when the insulin receptors on cells lose responsiveness to insulin, diminishing the cell's capacity to take up glucose, resulting in elevated blood glucose levels. To receive a diagnosis of Type 2 diabetes, a series of blood glucose tests are necessary to assess whether the blood glucose falls within normal parameters. If the result is out of the normal range, a patient may be diagnosed as prediabetic or diabetic, depending on the...
01:15Diabetes: Symptoms, Diagnosis, and Complications
For most patients, experiencing several weeks of polyuria, polydipsia, fatigue, and significant weight loss may indicate the presence of diabetes. Furthermore, adults displaying the phenotypic appearance of type 2 diabetes (particularly those who are obese and not initially insulin-requiring), may have islet cell autoantibodies, suggesting autoimmune-mediated β cell destruction and a diagnosis of latent autoimmune diabetes of adults (LADA). The categorization of glucose homeostasis is based on...
01:15Diabetes: Management and Pharmacotherapy
The therapy for diabetes aims to alleviate hyperglycemia-related symptoms, prevent acute metabolic decompensation, and reduce chronic end-organ complications. Glycemic control is evaluated through short-term (self-monitoring, continuous glucose monitoring) and long-term (A1c, fructosamine) metrics, enabling near real-time tracking of blood glucose levels and reflecting glycemic control over specific time frames.
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
01:22Diabetes Mellitus: Overview and Type I Subtype
Diabetes mellitus is a chronic metabolic disorder characterized by high blood glucose levels due to inadequate insulin production, insulin resistance, or both. The condition affects millions worldwide and can significantly impact their health and quality of life.
Type 1 diabetes is an autoimmune disease in which the immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. As a result, the body is unable to produce sufficient insulin, and individuals with...
Type 1 diabetes is an autoimmune disease in which the immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. As a result, the body is unable to produce sufficient insulin, and individuals with...