Related Experiment Video
Updated: Jun 28, 2025
10:37
Comparative Proteomic Analysis of Whole Kidney, Medulla, and Cortical Tubules in Diabetic Pathogenesis of Kidney Injury in Mice
Published on: May 2, 2025
145
Using nephropathy as an outcome to determine the HbA1c diagnostic threshold for type 2 diabetes
Alexandra E Butler1, Steven C Hunt2, Eric S Kilpatrick3
1Research Department, Royal College of Surgeons Ireland Bahrain, Adliya, Bahrain.
Diabetes & Metabolic Syndrome
|April 14, 2024
Summary
The current hemoglobin A1c (HbA1c) threshold for diagnosing diabetes does not need to be changed to account for diabetic nephropathy risk. This study found no HbA1c level below 7.0% effectively predicts nephropathy in a high-prevalence population.
Area of Science:
- Endocrinology and Metabolism
- Nephrology
- Diabetes Diagnostics
Background:
- The established diagnostic threshold for type 2 diabetes (T2D) using hemoglobin A1c (HbA1c) is 6.5% (48 mmol/mol), primarily based on retinopathy prevalence.
- The HbA1c threshold for predicting diabetic nephropathy, a less common early complication, remains unclear.
- Investigating a high diabetes prevalence population is crucial to re-evaluate diagnostic thresholds for nephropathy.
Purpose of the Study:
- To determine if a specific HbA1c diagnostic threshold can be established for predicting nephropathy.
- To compare the predictive value of HbA1c for nephropathy versus retinopathy in individuals without known T2D.
- To assess HbA1c cut-points for predicting nephropathy in a population with high diabetes prevalence.
Main Methods:
- Analysis of urine albumin:creatinine ratios (UACRs) in 2920 healthy individuals from the Qatar Biobank with HbA1c ≥ 5.6%.
- Nephropathy was defined as UACR ≥ 30 mg/g.
- HbA1c prediction for nephropathy was evaluated using cut-points ranging from 5.7% to 7.0%.
Main Results:
- A significant trend of increased abnormal UACR prevalence was observed as HbA1c increased (p < 0.01), primarily driven by individuals with HbA1c ≥ 7.0% (53 mmol/mol).
- Odds ratios for abnormal UACR were comparable across HbA1c thresholds from 5.7% to 6.9%, with a narrow range of 1.2-1.6.
- Area-under-receiver-operating characteristic curve analysis did not identify any HbA1c threshold below 7.0% as an optimal predictor of nephropathy.
Conclusions:
- No HbA1c threshold below 7.0% was found to predict an increased prevalence of nephropathy, even in a high-prevalence population.
- The existing retinopathy-based HbA1c diagnostic threshold of 6.5% does not require adjustment to incorporate diabetes nephropathy risk.
- Current HbA1c diagnostic criteria appear adequate for identifying individuals at risk for both retinopathy and nephropathy.
More Related Videos
Related Concept Videos
01:15Diabetes: Symptoms, Diagnosis, and Complications
528
For most patients, experiencing several weeks of polyuria, polydipsia, fatigue, and significant weight loss may indicate the presence of diabetes. Furthermore, adults displaying the phenotypic appearance of type 2 diabetes (particularly those who are obese and not initially insulin-requiring), may have islet cell autoantibodies, suggesting autoimmune-mediated β cell destruction and a diagnosis of latent autoimmune diabetes of adults (LADA). The categorization of glucose homeostasis is...
528
01:22Diabetes Mellitus: Type 2 and Gestational
2.3K
Type 2 diabetes, characterized by insulin resistance, arises when the insulin receptors on cells lose responsiveness to insulin, diminishing the cell's capacity to take up glucose, resulting in elevated blood glucose levels. To receive a diagnosis of Type 2 diabetes, a series of blood glucose tests are necessary to assess whether the blood glucose falls within normal parameters. If the result is out of the normal range, a patient may be diagnosed as prediabetic or diabetic, depending on the...
2.3K
01:36Carbohydrate Metabolism
11.1K
Carbohydrates are polymers composed of molecules containing atoms of carbon, hydrogen and oxygen. One gram of carbohydrate can provide four kilo-calories of energy, which makes it the most efficient instant energy source.
Starch accounts for approximately 60% of the carbohydrates consumed by humans. Since amylase enzymes cannot function in the stomach's acidic environment, starch can only be digested in the mouth and small intestine. Simple sugars are found naturally in milk and fruits in...
Starch accounts for approximately 60% of the carbohydrates consumed by humans. Since amylase enzymes cannot function in the stomach's acidic environment, starch can only be digested in the mouth and small intestine. Simple sugars are found naturally in milk and fruits in...
11.1K
01:22Diabetes Mellitus: Overview and Type I Subtype
2.6K
Diabetes mellitus is a chronic metabolic disorder characterized by high blood glucose levels due to inadequate insulin production, insulin resistance, or both. The condition affects millions worldwide and can significantly impact their health and quality of life.
Type 1 diabetes is an autoimmune disease in which the immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. As a result, the body is unable to produce sufficient insulin, and individuals with...
Type 1 diabetes is an autoimmune disease in which the immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. As a result, the body is unable to produce sufficient insulin, and individuals with...
2.6K
01:15Diabetes: Management and Pharmacotherapy
275
The therapy for diabetes aims to alleviate hyperglycemia-related symptoms, prevent acute metabolic decompensation, and reduce chronic end-organ complications. Glycemic control is evaluated through short-term (self-monitoring, continuous glucose monitoring) and long-term (A1c, fructosamine) metrics, enabling near real-time tracking of blood glucose levels and reflecting glycemic control over specific time frames.
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
275
01:20Pathophysiology of Diabetes
924
Diabetes mellitus is a chronic metabolic disorder characterized by hyperglycemia. The four categories of diabetes are type 1 diabetes, type 2 diabetes, other specific types of diabetes, and gestational diabetes.
Type 1 diabetes is characterized by autoimmune-mediated destruction of pancreatic β cells, with environmental factors potentially triggering this process in genetically susceptible individuals. Despite many not having a family history, certain genes increase susceptibility,...
Type 1 diabetes is characterized by autoimmune-mediated destruction of pancreatic β cells, with environmental factors potentially triggering this process in genetically susceptible individuals. Despite many not having a family history, certain genes increase susceptibility,...
924