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Re-examining the sensitivity of HbA1c to screen for diabetes mellitus
Chun W Yap1, Yee G Ang1, Timothy P L Quek2
1Health Services and Outcomes Research, National Healthcare Group, Singapore.
Insights
HbA1c is an effective screening tool for diabetes mellitus (DM) in real-world settings. This study found HbA1c screening for DM to be highly sensitive and specific, supporting its use in clinical practice.
Area of Science:
- Endocrinology
- Clinical Diagnostics
- Public Health
Background:
- The American Diabetes Association (ADA) recommends HbA1c testing for diabetes mellitus (DM) screening, especially for individuals who cannot fast.
- This study evaluated HbA1c's utility for DM screening in a real-world context, adhering to ADA diagnostic guidelines.
Purpose of the Study:
- To assess the effectiveness of HbA1c as a screening tool for diabetes mellitus (DM) in a diverse population.
- To determine if HbA1c meets diagnostic criteria when ADA repeat testing guidelines are followed.
Main Methods:
- A retrospective analysis of a chronic disease registry in Singapore (2005-2016).
- Included adults without prior DM diagnosis, with HbA1c and at least two confirmatory DM tests (fasting plasma glucose or 2-h plasma glucose) within 4 weeks.
- Data from 3928 adults were analyzed.
Main Results:
- HbA1c demonstrated a sensitivity of 85.2% and specificity of 82.3% at a 6.5% threshold.
- The area under the receiver operating characteristic curve was 0.914.
- Higher sensitivity was observed in females, younger individuals, and non-Chinese ethnicities.
Conclusions:
- HbA1c exhibits significantly higher sensitivity for DM screening than previously reported.
- These findings support the integration of HbA1c testing into routine DM screening protocols.
- HbA1c is a valuable tool for identifying potential diabetes cases efficiently.
Background:
One of the laboratory tests recommended by the American Diabetes Association (ADA) to screen for diabetes mellitus (DM) is HbA1c, and it is particularly suitable for segments of the population that cannot or are unwilling to fast for a screening test. The aim of this study was to determine whether HbA1c would be a useful tool to screen for DM in a real-world setting if ADA guidelines for repeat testing to confirm the diagnosis of DM are strictly adhered to.
Methods:
A retrospective database study was performed by extracting demographic and laboratory data from a chronic disease registry that collects data on adults from three tertiary hospitals and nine large primary care clinics in Singapore. Data were extracted and analyzed for adults not previously known to have DM whose data was captured in the registry between 2005 and 2016 with HbA1c and at least two diagnostic tests for DM (fasting plasma glucose or 2-h plasma glucose) performed within 4 weeks after HbA1c determination.
Results:
In all, 3928 adults were included in this study. The sensitivity, specificity, and area under the receiver operating characteristic curve for HbA1c at a threshold of 6.5% were 85.2%, 82.3%, and 0.914, respectively. A higher sensitivity was found in female adults, younger adults, and those of non-Chinese ethnicity.
Conclusions:
The sensitivity of HbA1c as a screening test for DM in this study was significantly higher than that reported previously. This work provides additional evidence supporting the inclusion of HbA1c as one of the screening tests for DM.
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