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Prediabetes: The Variation between HbA1c and Fasting Plasma Glucose
K A M White1,2, S Daneshvari3, J Lilyquist1,2
1Molecular Epidemiology Laboratory, University of New Mexico, Albuquerque, New Mexico, USA.
HbA1c testing identifies more cases of prediabetes and diabetes than Fasting Plasma Glucose (FPG) testing, especially in diverse populations. This difference in sensitivity has significant implications for healthcare policy and practice regarding diabetes screening.
Area of Science:
- Endocrinology
- Public Health
- Gerontology
Background:
- Type 2 Diabetes Mellitus (T2DM) prevalence is increasing globally.
- Fasting Plasma Glucose (FPG) and Hemoglobin A1c (HbA1c) are standard diagnostic markers for diabetes and prediabetes.
- Understanding diagnostic discrepancies is crucial for effective population health management.
Purpose of the Study:
- To compare the prevalence of diabetes, prediabetes, and glycemic control using FPG versus HbA1c.
- To analyze these differences in elderly Hispanic and non-Hispanic White populations in New Mexico.
- To inform future healthcare policy and clinical practice.
Main Methods:
- Comparative analysis of HbA1c and FPG diagnostic criteria.
- Chi-Square analysis to assess agreement across gender and ethnicity.
- Non-parametric regression with locally weighted smoothing to explore FPG-HbA1c relationships.
Main Results:
- Significant variation in sensitivity between HbA1c and FPG for identifying prediabetes and diabetes.
- HbA1c identified more individuals with prediabetes (30% overlap) and diabetes compared to FPG.
- Poor overall agreement (Kappa 0.22-0.34) between HbA1c and FPG, particularly by sex and ethnicity.
- Hispanics showed higher rates of uncontrolled diabetes.
Conclusions:
- HbA1c and FPG exhibit differing sensitivities for diabetes detection across ethnic groups.
- Utilizing HbA1c over FPG leads to higher reported rates of prediabetes and diabetes.
- Findings necessitate re-evaluation of screening strategies and healthcare resource allocation.
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