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Screening for Pre-diabetes Works

The use of A1c plus FPG had the best performance in reducing the likelihood of missing future cases of diabetes….

The combination of HbA1c 5.7-6.4% (39-46 mmol/mol) and fasting plasma glucose of 100-125ng/dL.(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 fulfill HbA1c 6.0-6.4% (42-46 mmol/mol) (and fasting plasma glucose 110-125mg/dL.(6.1-6.9 mmol/l) would predict definite progression to diabetes.

The study included 4670 men and 1571 women without diabetes. [Diabetes was defined by: fasting plasma glucose ≥ 126mg/dL (7.0 mmol/l); HbA1c≥ 6.5% (≥48 mmol/mol); or self-reported clinician-diagnosed diabetes].

Pre-diabetes was diagnosed by a combination of impaired fasting glucose. [Fasting plasma glucose 100-125mg/dL ( 5.6-6.9 mmol/l) or 110-125mg/dL.(6.1-6.9 mmol/l) and elevated HbA1c 5.7-6.4% (39-46 mmol/mol) or 6.0-6.4%.[

The results showed that, during a 5-year follow-up, 338 incident cases of diabetes occurred. The combination of HbA1c 5.7-6.4% and fasting plasma glucose 100-125mg/dL.(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 normoglycemic 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 6.0-6.4 (42-46 mmol/mol) (and fasting plasma glucose 110-125mg/dL.(6.1-6.9 mmol/l) had a 100% cumulative risk of developing diabetes.

Diabetic Medicine, 08/28/2012