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Erschienen in: Acta Diabetologica 4/2016

21.01.2016 | Original Article

The 1-hour post-load glucose level is more effective than HbA1c for screening dysglycemia

verfasst von: Ram Jagannathan, Mary Ann Sevick, Dorothy Fink, Rachel Dankner, Angela Chetrit, Jesse Roth, Martin Buysschaert, Michael Bergman

Erschienen in: Acta Diabetologica | Ausgabe 4/2016

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Abstract

Aim

To assess the performance of HbA1c and the 1-h plasma glucose (PG ≥ 155 mg/dl; 8.6 mmol/l) in identifying dysglycemia based on the oral glucose tolerance test (OGTT) from a real-world clinical care setting.

Methods

This was a diagnostic test accuracy study. For this analysis, we tested the HbA1c diagnostic criteria advocated by the American Diabetes Association (ADA 5.7–6.4 %) and International Expert Committee (IEC 6.0–6.4 %) against conventional OGTT criteria. We also tested the utility of 1-h PG ≥ mg/dl; 8.6 mmol/l. Prediabetes was defined according to ADA-OGTT guidelines. Spearman correlation tests were used to determine the relationships between HbA1c, 1-h PG with fasting, 2-h PG and indices of insulin sensitivity and β-cell function. The levels of agreement between diagnostic methods were ascertained using Cohen’s kappa coefficient (Κ). Receiver operating characteristic (ROC) curve was used to analyze the performance of the HbA1c and 1-h PG test in identifying prediabetes considering OGTT as reference diagnostic criteria. The diagnostic properties of different HbA1c thresholds were contrasted by determining sensitivity, specificity and likelihood ratios (LR).

Results

Of the 212 high-risk individuals, 70 (33 %) were identified with prediabetes, and 1-h PG showed a stronger association with 2-h PG, insulin sensitivity index, and β-cell function than HbA1c (P < 0.05). Furthermore, the level of agreement between 1-h PG ≥ 155 mg/dl (8.6 mmol/l) and the OGTT (Κ[95 % CI]: 0.40[0.28–0.53]) diagnostic test was stronger than that of ADA-HbA1c criteria 0.1[0.03–0.16] and IEC criteria (0.17[0.04–0.30]). The ROC (AUC[95 % CI]) for HbA1c and 1-h PG were 0.65[0.57–0.73] and 0.79[0.72–0.85], respectively. Importantly, 1-h PG ≥ 155 mg/dl (8.6 mmol/l) showed good sensitivity (74.3 % [62.4–84.0]) and specificity 69.7 % [61.5–77.1]) with a LR of 2.45. The ability of 1-h PG to discriminate prediabetes was better than that of HbA1c (∆AUC: −0.14; Z value: 2.5683; P = 0.01022).

Conclusion

In a real-world clinical practice setting, the 1-h PG ≥ 155 mg/dl (8.6 mmol/l) is superior for detecting high-risk individuals compared with HbA1c. Furthermore, HbA1c is a less precise correlate of insulin sensitivity and β-cell function than the 1-h PG and correlates poorly with the 2-h PG during the OGTT.
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Metadaten
Titel
The 1-hour post-load glucose level is more effective than HbA1c for screening dysglycemia
verfasst von
Ram Jagannathan
Mary Ann Sevick
Dorothy Fink
Rachel Dankner
Angela Chetrit
Jesse Roth
Martin Buysschaert
Michael Bergman
Publikationsdatum
21.01.2016
Verlag
Springer Milan
Erschienen in
Acta Diabetologica / Ausgabe 4/2016
Print ISSN: 0940-5429
Elektronische ISSN: 1432-5233
DOI
https://doi.org/10.1007/s00592-015-0829-6

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