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Comparing glucose and hemoglobin A1c diagnostic tests among a high metabolic risk Hispanic population
Mónica A Vega-Vázquez1, Margarita Ramírez-Vick1, Francisco J Muñoz-Torres2
1Department of Medicine, Endocrinology, Diabetes and Metabolism Section, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico.
Insights
Glycated hemoglobin (HbA1c) testing shows low agreement with glucose levels for diagnosing prediabetes and diabetes. Different diagnostic criteria result in varied metabolic profiles, suggesting a combined testing approach may be optimal.
Area of Science:
- Endocrinology
- Metabolic Disorders
- Diagnostic Testing
Background:
- Glycated hemoglobin (HbA1c) and plasma glucose criteria are used to diagnose prediabetes and diabetes.
- Understanding the differences in metabolic profiles based on these diagnostic methods is crucial for effective patient management.
Purpose of the Study:
- To compare the diagnostic accuracy of HbA1c and plasma glucose criteria for prediabetes and diabetes.
- To compare the metabolic profiles of individuals classified by HbA1c versus plasma glucose levels.
Main Methods:
- The San Juan Overweight Adults Longitudinal Study recruited 1342 Hispanic adults aged 40-65 without diagnosed diabetes.
- Participants were classified based on baseline HbA1c and plasma glucose levels into normal glycemic, prediabetes, or diabetes categories.
- Baseline cardiometabolic factors were compared across different classification groups.
Main Results:
- Concordance between HbA1c and plasma glucose criteria was 55.1%.
- HbA1c showed reasonable validity for diabetes (AUC=0.76) but not prediabetes (AUC=0.62).
- Individuals classified by different criteria exhibited distinct cardiometabolic profiles, with notable differences in blood pressure, BMI, insulin resistance, and other metabolic markers.
Conclusions:
- There is low concordance between HbA1c and plasma glucose measurements for diagnosing prediabetes and diabetes.
- HbA1c is less reliable for prediabetes diagnosis but shows reasonable validity for diabetes in this population.
- Different diagnostic criteria lead to distinct metabolic profiles, suggesting a combined testing approach may be beneficial.
Background:
Compare glycated hemoglobin (HbA1c ) diagnostic tests for prediabetes and diabetes with plasma glucose criteria and compare the metabolic profiles of people classified by HbA1c versus by glucose levels.
Methods:
Participants were recruited for the San Juan Overweight Adults Longitudinal Study. The participants were primarily Hispanic (98%), without previously diagnosed diabetes, and aged 40 to 65 years. Participants classified as normal glycemic, prediabetes, or diabetes on the basis of baseline HbA1c and plasma glucose criteria were compared with respect to baseline cardiometabolic factors.
Results:
The 1342 participants had a mean age of 50.5 ± 6.8 years and 28% were men. Thirty-one percent were diagnosed with prediabetes by plasma glucose criteria and 53.4% by HbA1c , and 8.1% were diagnosed with diabetes by plasma glucose criteria and 6.3% by HbA1c ; overall concordance rate was 55.1%. The area under the receiver operating characteristic curve of HbA1c compared to plasma glucose criteria was 0.62 for impaired glucose and 0.76 for diabetes. A worse cardiometabolic profile was seen within subgroups that met HbA1c and plasma glucose criteria for diabetes or prediabetes. Those diagnosed with prediabetes by plasma glucose criteria had significantly higher systolic blood pressure and higher homeostatic model assessment than those diagnosed using HbA1c . Participants diagnosed with diabetes by plasma glucose criteria had lower body mass index, smaller waist circumference, and lower insulinogenic and disposition indices, but higher homeostatic model assessment of insulin resistance, than those diagnosed by HbA1c .
Conclusions:
Low concordance was seen between HbA1c and glucose measurements. The HbA1c is not a good test for prediabetes but shows reasonable validity for diabetes in this high-risk predominantly female Hispanic population. People classified by HbA1c , plasma glucose criteria, or both show different metabolic profiles; a combined test may be ideal.
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