HbA(1c) alone is a poor indicator of cardiometabolic risk in middle-aged subjects with pre-diabetes but is suitable for type 2 diabetes diagnosis: a cross-sectional study

dc.contributor.authorMillar, Sean R.
dc.contributor.authorPerry, Ivan J.
dc.contributor.authorPhillips, Catherine M.
dc.contributor.funderHealth Research Board
dc.description.abstractObjectives: Glycated haemoglobin A(1c) (HbA(1c)) measurement is recommended as an alternative to fasting plasma glucose (FPG) for the diagnosis of pre-diabetes and type 2 diabetes. However, evidence suggests discordance between HbA(1c) and FPG. In this study we examine a range of metabolic risk features, pro-inflammatory cytokines, acute-phase response proteins, coagulation factors and white blood cell counts to determine which assay more accurately identifies individuals at increased cardiometabolic risk. Materials and Methods: This was a cross-sectional study involving a random sample of 2,047 men and women aged 46-73 years. Binary and multinomial logistic regression were employed to examine risk feature associations with pre-diabetes [either HbA1c levels 5.7-6.4%(39-46 mmol/mol) or impaired FPG levels 5.6-6.9 mmol/l] and type 2 diabetes [either HbA1c levels > 6.5% (> 48 mmol/mol) or FPG levels > 7.0 mmol/l]. Receiver operating characteristic curve analysis was used to evaluate the ability of HbA(1c) to discriminate pre-diabetes and diabetes defined by FPG. Results: Stronger associations with diabetes-related phenotypes were observed in pre-diabetic subjects diagnosed by FPG compared to those detected by HbA(1c). Individuals with type 2 diabetes exhibited cardiometabolic profiles that were broadly similar according to diagnosis by either assay. Pre-diabetic participants classified by both assays displayed a more pro-inflammatory, pro-atherogenic, hypertensive and insulin resistant profile. Odds ratios of having three or more metabolic syndrome features were also noticeably increased (OR: 4.0, 95% CI: 2.8-5.8) when compared to subjects diagnosed by either HbA(1c) (OR: 1.4, 95% CI: 1.2-1.8) or FPG (OR: 3.0, 95% CI: 1.7-5.1) separately. Conclusions: In middle-aged Caucasian-Europeans, HbA(1c) alone is a poor indicator of cardiometabolic risk but is suitable for diagnosing diabetes. Combined use of HbA(1c) and FPG may be of additional benefit for detecting individuals at highest odds of type 2 diabetes development.en
dc.description.sponsorshipHealth Research Board (HRC/2007/13)en
dc.description.statusPeer revieweden
dc.description.versionPublished Versionen
dc.identifier.citationMillar SR, Perry IJ, Phillips CM (2015) HbA1c Alone Is a Poor Indicator of Cardiometabolic Risk in Middle-Aged Subjects with Pre-Diabetes but Is Suitable for Type 2 Diabetes Diagnosis: A Cross-Sectional Study. PLoS ONE 10(8): e0134154. doi:10.1371/journal.pone.0134154
dc.identifier.journaltitlePLOS ONEen
dc.publisherPublic Library of Scienceen
dc.rights© 2015 Millar et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are crediteden
dc.subjectFasting plasma glucoseen
dc.subjectAmerican Heart Associationen
dc.subjectCardiovascular diseaseen
dc.subjectMetabolic syndromeen
dc.subjectGlycated hemoglobinen
dc.subjectOlder adultsen
dc.subjectHealth careen
dc.titleHbA(1c) alone is a poor indicator of cardiometabolic risk in middle-aged subjects with pre-diabetes but is suitable for type 2 diabetes diagnosis: a cross-sectional studyen
dc.typeArticle (peer-reviewed)en
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