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Glycated hemoglobin cannot yet be proposed as a screening tool for cystic fibrosis related diabetes
Valérie Boudreau1, Adèle Coriati1, Katherine Desjardins1
1Institut de Recherches Cliniques de Montréal, Montréal, Québec, H2W 1R7, Canada; Department of Nutrition, Université de Montréal, Montréal, Québec, Canada.
Insights
Glycated hemoglobin (HbA1c) is not a reliable screening tool for CF-related diabetes (CFRD). A proposed HbA1c threshold of ≥5.8% would miss over 30% of CFRD diagnoses, highlighting the limitations of HbA1c testing for this patient group.
Area of Science:
- Endocrinology
- Pulmonology
- Metabolic Disorders
Background:
- Cystic fibrosis (CF) patients are living longer, leading to increased prevalence of CF-related diabetes (CFRD).
- The oral glucose tolerance test (OGTT) is the current standard for CFRD detection but is burdensome and controversial.
- Alternative screening methods for CFRD are being investigated due to OGTT limitations.
Purpose of the Study:
- To evaluate the efficacy of glycated hemoglobin (HbA1c) as a screening tool for CFRD.
- To compare HbA1c values with OGTT results in a cohort of CF patients.
Main Methods:
- Analysis of OGTT and HbA1c values from 207 CF patients between 2004 and 2015.
- Assessment of a proposed HbA1c threshold of ≥5.8% (39.9 mmol/mol) for CFRD screening.
Main Results:
- A threshold of HbA1c ≥5.8% demonstrated a sensitivity of 68.2% and a specificity of 60.5%.
- Using this HbA1c threshold would result in missing 31.8% of potential CFRD diagnoses.
- The diagnostic performance indicates significant limitations for HbA1c as a sole screening method.
Conclusions:
- Glycated hemoglobin (HbA1c) does not possess the necessary characteristics for a suitable screening test for CFRD.
- Current evidence suggests HbA1c is inadequate for identifying CF patients who require OGTT.
- Further research is needed to identify reliable and less burdensome alternatives to OGTT for CFRD screening.
Abstract:
With improved life expectancy of cystic fibrosis (CF) patients, CF-related diabetes (CFRD) has become a major complication. The oral glucose tolerance test (OGTT) is the standard test to detect it. However, the use of OGTT is controversial, in addition to being a burden for patients and the treatment team. Research to find alternative ways of testing is ongoing. While some propose that glycated hemoglobin (HbA1c) may be an effective alternative, our past results suggest otherwise. A new analysis involving the OGTT and HbA1c values of 207 patients, between 2004 and 2015, proposes that the threshold of a lower value of HbA1c of ≥5.8%(39.9 mmol/mol) gives a sensitivity of 68.2% and a specificity of 60.5%. With such sensitivity to identify patients in need of an OGTT, 31.8% of CFRD diagnosis would be missed if the suggested HbA1c value of ≥5.8% was used as a screening tool to identify patients in need of OGTTs. Considering our results, we believe the HbA1c does not possess the characteristics of a suitable screening test for CFRD.
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