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Reconsidering the HbA1c Cutoff for Diabetes Diagnosis Based on a Large Chinese Cohort
Jiying Qi1, Yang Su2,3, Qianqian Song1
1Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.
Insights
Hemoglobin A1c (HbA1c) levels increase with age and body mass index (BMI), with variations influenced by gender. These factors, especially in younger adults, challenge the standard HbA1c diagnostic cutoff for diabetes.
Area of Science:
- Endocrinology
- Clinical Chemistry
- Public Health
Background:
- Hemoglobin A1c (HbA1c) is a key biomarker for diabetes diagnosis and management.
- Factors like age, gender, and body mass index (BMI) may influence HbA1c levels, potentially affecting diagnostic accuracy.
- The study investigates these influences to refine HbA1c interpretation.
Purpose of the Study:
- To examine the correlation between age and HbA1c levels.
- To determine if gender and BMI modify the relationship between age and HbA1c.
- To assess the applicability of standard HbA1c cutoffs across different demographic groups.
Main Methods:
- A cross-sectional study analyzed data from 135,893 non-diabetic individuals examined between 2013 and 2017.
- Subjects were stratified by gender, age, and BMI to analyze interactive and independent effects on HbA1c.
- Median HbA1c levels and 95% confidence intervals were calculated.
Main Results:
- HbA1c levels showed a consistent increase with age in both males and females.
- A positive association was observed between BMI and HbA1c levels.
- The age-related increase in HbA1c was more pronounced in individuals with higher BMI, and vice versa.
- The 97.5th percentile of HbA1c was below 6.5% for most individuals aged 20-59, questioning the universal cutoff.
Conclusions:
- Age, gender, and BMI significantly impact HbA1c levels.
- The findings suggest that a single HbA1c cutoff may not be appropriate for all individuals, particularly the young and middle-aged.
- Recommendations emphasize considering these demographic factors in diabetes diagnosis and management using HbA1c.
Introduction:
The HbA1c has been considered as the 'gold standard' in diabetes diagnosis and management, however, age, gender and body mass index (BMI) might have certain effects on HbA1c. We are aiming to further investigate the correlation between age and HbA1c, and whether it was affected by gender and BMI.
Methods:
A cross-sectional survey including 135,893 nondiabetic individuals who took the physical examination between 2013 and 2017 was conducted. The subjects were grouped by gender, age and BMI, and the interactive and independent effects of the 3 factors on the HbA1c were detected. The median and 95% confidence interval (CI) of HbA1c levels were calculated.
Results:
The HbA1c levels gradually increased along with age, both in female and male, and there is a positive association between BMI and the HbA1c. The difference on HbA1c in gender was associated with both age and BMI, the age-related increase in HbAlc was accentuated in the subgroup with higher BMI, and there was a marked accentuation of the positive association between BMI and HbA1c as age increased. In almost all the young and middle-aged (aged 20-59) subgroups, the 97.5th percentiles of HbA1c levels were lower than 6.5%, suggesting that the single HbA1c cutoff value is probably not applicable to the young and middle-aged population.
Conclusions:
We recommend that the effects of age, gender and BMI should be taken into consideration when using HbA1c for the diagnosis and management of diabetes, especially in the young and middle-aged population.
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