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Preventing misdiagnosis of diabetes in the elderly: age-dependent HbA1c reference intervals derived from two

Annette Masuch1, Nele Friedrich1,2, Johannes Roth3,4

  • 1Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany.

BMC Endocrine Disorders
|February 14, 2019
PubMed

Insights

Glycated hemoglobin A1c (HbA1c) naturally increases with age in non-diabetic individuals. New age-specific reference intervals for HbA1c can improve diabetes diagnosis and prevent overtreatment in older adults.

Area of Science:

  • Clinical Chemistry
  • Endocrinology
  • Geriatrics

Background:

  • Glycated hemoglobin A1c (HbA1c) is crucial for diabetes diagnosis and therapy monitoring.
  • Previous studies suggest elevated HbA1c in non-diabetic elderly, but this is not widely adopted.
  • Lack of age-specific reference intervals hinders accurate interpretation of HbA1c in aging populations.

Purpose of the Study:

  • To investigate the relationship between HbA1c levels and age in two independent population-based cohorts.
  • To establish age-specific reference intervals for HbA1c.
  • To provide evidence for updating clinical guidelines regarding HbA1c interpretation in the elderly.

Main Methods:

  • Analysis of 4,263 participants from the Study of Health in Pomerania (SHIP-0) and 4,402 from SHIP-Trend.
  • HbA1c measurement using high-performance liquid chromatography.
  • Application of multivariable linear regression and ANOVA to derive age-specific reference intervals.

Main Results:

  • HbA1c levels showed a consistent increase with age in both cohorts, independent of BMI.
  • Upper reference limits for HbA1c were established: 42.1 mmol/mol (6.0%) for ages 20-39, 43.2 mmol/mol (6.1%) for 40-59, and 47.5 mmol/mol (6.5%) for ages ≥60.
  • Estimated mean HbA1c levels were significantly higher in the oldest compared to the youngest age groups.

Conclusions:

  • The study confirms that HbA1c levels increase with age in non-diabetic individuals.
  • Derived age-dependent reference values for HbA1c can enhance diagnostic accuracy.
  • Implementing these age-specific intervals may prevent misdiagnosis and overtreatment of diabetes in the elderly.
Abstract

Keywords:
Age-dependencyDiabetes diagnosisElderlyHbA1cUpper reference limit

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