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- Title
Glycated Hemoglobin A<sub>1c</sub> as Screening for Diabetes Mellitus in HIV-Infected Individuals.
- Authors
Eckhardt, Benjamin J.; Holzman, Robert S.; Kwan, Candice K.; Baghdadi, Jonathan; Aberg, Judith A.
- Abstract
The American Diabetes Association now recommends hemoglobin A1c (HbA1c) screening for the diagnosis of diabetes. It has been reported that HbA1c levels underestimate glycemic levels in HIV-infected persons. We examined the performance of HbA1c as a screening test for diabetes in a group of HIV-infected people without diabetes. We conducted a retrospective cross-sectional cohort study among HIV-infected patients determining the sensitivity and specificity of HbA1c as a screening test compared to fasting blood glucose (FBG). The effect of treatment regimen on the relationship between HbA1c and FBG was assessed by multiple linear regressions. Twenty-two of the 395 patients included in the study were newly diagnosed with diabetes based on FBG≥126 mg/dL. Using a cutoff of HbA1c≥6.5%, HbA1c had a sensitivity of 40.9% and specificity of 97.5% for identification of incident diabetes. At an HbA1c level of 5.8% the product of sensitivity and specificity was maximized, with values of 88.8% and 77.5% respectively. Higher mean cell volume (MCV) values ( p=0.02) and current use of a non-nucleoside reverse transcriptase inhibitors (NNRTIs; p=0.02) significantly increased the slope, while PI use significantly decreased the slope ( p<0.001), of the linear regression of HbA1c compared to FBG. Tenofovir use did not significantly alter the slope or y-intercept of the line. Among HIV-infected nondiabetic patients, HbA1c is insensitive, although highly specific for diagnosing diabetes. Current antiretroviral (ART) use has significant and variable influence on the relationship between HbA1c and FBG. The use of HbA1c in conjunction with FBG may be the best modality to screen for diabetes.
- Subjects
NEW York (State); DIAGNOSIS of diabetes; MEDICAL screening; ERYTHROCYTES; BLOOD testing; BLOOD sugar; CHI-squared test; GLYCOSYLATED hemoglobin; HIV-positive persons; LONGITUDINAL method; RESEARCH funding; ANTIRETROVIRAL agents; MULTIPLE regression analysis; CROSS-sectional method; RETROSPECTIVE studies; RECEIVER operating characteristic curves; DATA analysis software; DESCRIPTIVE statistics
- Publication
AIDS Patient Care & STDs, 2012, Vol 26, Issue 4, p197
- ISSN
1087-2914
- Publication type
Article
- DOI
10.1089/apc.2011.0379