HbA1c identifies adults at high risk for Type 2 diabetes, CVD
MedWire News: Use of glycated hemoglobin (HbA1c) cutoff points could provide a simple but effective method for predicting which patients are likely to benefit most from intensive lifestyle interventions due to prediabetes or elevated cardiovascular disease (CVD) risk, show study results.
"Type 2 diabetes is growing rapidly with the increasing rate of obesity and has reached epidemic proportions in this country," said lead study author Ronald Ackermann from Indiana School of Medicine in Indianapolis, USA.
"Identifying prediabetics and halting the disease could prevent millions of individuals from developing diabetes and would avert the very high future costs of treating it. Lifestyle interventions in the prediabetic stage offer benefit not only by preventing Type 2 diabetes but also by reducing cardiovascular risk factors," he added.
Using data from the 2005-2006 National Health and Nutrition Examination Survey, Ackermann and colleagues estimated the 7.5-year probability of developing Type 2 diabetes and the 10-year probability of developing CVD using the previously developed methods of Stern and colleagues and the Framingham General CVD Risk Engine, respectively.
In adults meeting the American Diabetes Association 2003 definition of prediabetes (fasting plasma glucose 100-125 mg/dl; not involving measurement of HbA1c), the risk for incident Type 2 diabetes (over 7.5 years) and CVD (over 10 years) was 33.5% and 10.7%, respectively.
Similarly, Ackermann and team estimated that using HbA1c measures of 5.50-6.49% alone, the corresponding Type 2 diabetes and CVD risks would be 32.4% and 11.4%.
They also found that use of a slightly higher HbA1c cutoff of 5.7% or above would identify individuals with a 41.3% and 13.3% risk for incident diabetes or CVD, respectively, which are comparable to the risks for people enrolled in the Diabetes Prevention Program, a classic example of a intensive lifestyle intervention.
The current gold standard for assessing risk for diabetes is by testing fasting plasma glucose and 2-hour plasma glucose, which can be time consuming and leads to a large number of people remaining untested.
"Since health plans are beginning to pay for prediabetes treatments, doctors now have a more compelling reason to encourage patients who have risk factors to complete a screening test," said Ackermann.
"The more practical HbA1c test could help doctors perform testing on a much larger scale than ever before."
The results of this study are published in the American Journal of Preventive Medicine.
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By Helen Albert