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- Title
Screening for pre-diabetes to predict future diabetes using various cut-off points for HbA<sub>1c</sub> and impaired fasting glucose: the Toranomon Hospital Health Management Center Study 4 (TOPICS 4).
- Authors
Heianza, Y.; Arase, Y.; Fujihara, K.; Tsuji, H.; Saito, K.; Hsieh, S. D.; Kodama, S.; Shimano, H.; Yamada, N.; Hara, S.; Sone, H.
- Abstract
Diabet. Med. 29, e279-e285 (2012) Abstract Aim To evaluate various screening criteria for pre-diabetes to identify which combination of impaired fasting glucose and elevated HbA1c values performs most effectively in predicting future diabetes in a large cohort of Japanese individuals. Methods The study included 4670 men and 1571 women without diabetes (diabetes: fasting plasma glucose ≥ 7.0 mmol/l, HbA1c≥ 48 mmol/mol (≥ 6.5%), or self-reported clinician-diagnosed diabetes). Pre-diabetes was diagnosed by a combination of impaired fasting glucose (fasting plasma glucose 5.6-6.9 mmol/l or 6.1-6.9 mmol/l) and elevated HbA1c [39-46 mmol/mol (5.7-6.4%) or 42-46 mmol/mol (6.0-6.4%)]. Results During a 5-year follow-up, 338 incident cases of diabetes occurred. The combination of HbA1c 39-46 mmol/mol (5.7-6.4%) and fasting plasma glucose 5.6-6.9 mmol/l yielded the highest sensitivity (86%) and generated a large population-attributable per cent risk (78%) for predicting development of diabetes. Among individuals classified as having pre-diabetes by any of the four combined criteria, 20.5-32.0% reverted to the normoglycaemic state as having neither elevated HbA1c nor impaired fasting glucose at the last follow-up examination. At 5.6 years after the baseline examination, however, pre-diabetic individuals who fulfilled both HbA1c 42-46 mmol/mol (6.0-6.4%) and fasting plasma glucose 6.1-6.9 mmol/l had a 100% cumulative risk of developing diabetes. Conclusions The combination of HbA1c 39-46 mmol/mol (5.7-6.4%) and fasting plasma glucose 5.6-6.9 mmol/l would have the best performance in reducing the likelihood of missing future cases of diabetes. Identifying pre-diabetic individuals who strictly fulfil HbA1c 42-46 mmol/mol (6.0-6.4%) and fasting plasma glucose 6.1-6.9 mmol/l would predict definite progression to diabetes.
- Subjects
JAPAN; BLOOD sugar analysis; DIAGNOSIS of diabetes; DIABETES risk factors; ANALYSIS of triglycerides; BLOOD pressure; CHOLESTEROL; CONFIDENCE intervals; DIABETES; EPIDEMIOLOGY; FASTING; GLYCOSYLATED hemoglobin; HIGH density lipoproteins; HOSPITALS; PATIENT aftercare; LONGITUDINAL method; EVALUATION of medical care; MEDICAL screening; DATA analysis; PREDIABETIC state; KAPLAN-Meier estimator; DIAGNOSIS
- Publication
Diabetic Medicine, 2012, Vol 29, Issue 9, pe279
- ISSN
0742-3071
- Publication type
Article
- DOI
10.1111/j.1464-5491.2012.03686.x