The Role of Hemoglobin A1C in Diabetes Screening and Diabetic Retinopathy

Hemoglobin A1C (A1C) is used in various settings. Its performance has not been evaluated systemically. We compared A1C in diagnosis of diabetes with fasting plasma glucose (FPG) and 2-h postchallenged plasma glucose (2hPG) parameters in a cross-sectional cohort in the United Stated. Adult subjects (...

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Autores principales:	Maria Mercedes Chang Villacreses, Rudruidee Karnchanasorn, Horng-Yih Ou, Raynald Samoa, Lee-Ming Chuang, Ken C. Chiu
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	diabetes mellitus diagnosis sensitivity specificity retinopathy Medicine R
Acceso en línea:	https://doaj.org/article/b0d907f4d3af482dbea41b10b3fbfc2a
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spelling	oai:doaj.org-article:b0d907f4d3af482dbea41b10b3fbfc2a2021-11-11T17:34:59ZThe Role of Hemoglobin A1C in Diabetes Screening and Diabetic Retinopathy10.3390/jcm102149472077-0383https://doaj.org/article/b0d907f4d3af482dbea41b10b3fbfc2a2021-10-01T00:00:00Zhttps://www.mdpi.com/2077-0383/10/21/4947https://doaj.org/toc/2077-0383Hemoglobin A1C (A1C) is used in various settings. Its performance has not been evaluated systemically. We compared A1C in diagnosis of diabetes with fasting plasma glucose (FPG) and 2-h postchallenged plasma glucose (2hPG) parameters in a cross-sectional cohort in the United Stated. Adult subjects (≥20 years) were identified from the National Health and Nutrition Examination Survey 2005–2016 without a history of diabetes who had BMI, A1C, FPG, and 2hPG (<i>n</i> = 10,416). For comparisons, we calculated the sample weighted prevalence, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) with subgroup analyses. For the retinopathy study, diabetic subjects with established diabetes who responded to the question of diabetic retinopathy were evaluated (<i>n</i> = 3907). Compared to the FPG/2hPG criteria, A1C ≥ 48 mmol/mol (6.5%) had a low sensitivity at 25.90%, with specificity 99.70%, PPV 84.70%, and NPV 95.70%. Subgroup analyses revealed a lower sensitivity in males (24.52%); the lowest in non-Hispanic White (21.35%), in the third decade (14.32%), and in the BMI < 22.50 kg/m<sup>2</sup> group (7.21%). The prevalence of self-reported diabetic retinopathy increased drastically with an inflection point at A1C 48 mmol/mol (6.5%) from 11.52% to 18.32% (<i>p</i> < 0.0001). A1C ≥ 48 mmol/mol (6.5%) should be cautiously used to diagnose diabetes in certain subgroups due to very low sensitivity in certain groups. With the confirmation of the association of increasing self-reported diabetic retinopathy with A1C ≥ 48 mmol/mol (6.5%), the current A1C cutoff is an acceptable value with the understanding of especially low sensitivity in certain subgroups.Maria Mercedes Chang VillacresesRudruidee KarnchanasornHorng-Yih OuRaynald SamoaLee-Ming ChuangKen C. ChiuMDPI AGarticlediabetes mellitusdiagnosissensitivityspecificityretinopathyMedicineRENJournal of Clinical Medicine, Vol 10, Iss 4947, p 4947 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	diabetes mellitus diagnosis sensitivity specificity retinopathy Medicine R
spellingShingle	diabetes mellitus diagnosis sensitivity specificity retinopathy Medicine R Maria Mercedes Chang Villacreses Rudruidee Karnchanasorn Horng-Yih Ou Raynald Samoa Lee-Ming Chuang Ken C. Chiu The Role of Hemoglobin A1C in Diabetes Screening and Diabetic Retinopathy
description	Hemoglobin A1C (A1C) is used in various settings. Its performance has not been evaluated systemically. We compared A1C in diagnosis of diabetes with fasting plasma glucose (FPG) and 2-h postchallenged plasma glucose (2hPG) parameters in a cross-sectional cohort in the United Stated. Adult subjects (≥20 years) were identified from the National Health and Nutrition Examination Survey 2005–2016 without a history of diabetes who had BMI, A1C, FPG, and 2hPG (<i>n</i> = 10,416). For comparisons, we calculated the sample weighted prevalence, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) with subgroup analyses. For the retinopathy study, diabetic subjects with established diabetes who responded to the question of diabetic retinopathy were evaluated (<i>n</i> = 3907). Compared to the FPG/2hPG criteria, A1C ≥ 48 mmol/mol (6.5%) had a low sensitivity at 25.90%, with specificity 99.70%, PPV 84.70%, and NPV 95.70%. Subgroup analyses revealed a lower sensitivity in males (24.52%); the lowest in non-Hispanic White (21.35%), in the third decade (14.32%), and in the BMI < 22.50 kg/m<sup>2</sup> group (7.21%). The prevalence of self-reported diabetic retinopathy increased drastically with an inflection point at A1C 48 mmol/mol (6.5%) from 11.52% to 18.32% (<i>p</i> < 0.0001). A1C ≥ 48 mmol/mol (6.5%) should be cautiously used to diagnose diabetes in certain subgroups due to very low sensitivity in certain groups. With the confirmation of the association of increasing self-reported diabetic retinopathy with A1C ≥ 48 mmol/mol (6.5%), the current A1C cutoff is an acceptable value with the understanding of especially low sensitivity in certain subgroups.
format	article
author	Maria Mercedes Chang Villacreses Rudruidee Karnchanasorn Horng-Yih Ou Raynald Samoa Lee-Ming Chuang Ken C. Chiu
author_facet	Maria Mercedes Chang Villacreses Rudruidee Karnchanasorn Horng-Yih Ou Raynald Samoa Lee-Ming Chuang Ken C. Chiu
author_sort	Maria Mercedes Chang Villacreses
title	The Role of Hemoglobin A1C in Diabetes Screening and Diabetic Retinopathy
title_short	The Role of Hemoglobin A1C in Diabetes Screening and Diabetic Retinopathy
title_full	The Role of Hemoglobin A1C in Diabetes Screening and Diabetic Retinopathy
title_fullStr	The Role of Hemoglobin A1C in Diabetes Screening and Diabetic Retinopathy
title_full_unstemmed	The Role of Hemoglobin A1C in Diabetes Screening and Diabetic Retinopathy
title_sort	role of hemoglobin a1c in diabetes screening and diabetic retinopathy
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/b0d907f4d3af482dbea41b10b3fbfc2a
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The Role of Hemoglobin A1C in Diabetes Screening and Diabetic Retinopathy

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