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TOPICS 3: Using IFG plus HbA1c criterion further identified people at risk for diabetes
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ADA 71st Scientific Sessions
SAN DIEGO — The American Diabetes Association suggests that a HbA1c level ranging from 5.7% to 6.4% warrants a diagnosis of prediabetes. New data suggest that pairing this criterion with impaired fasting glucose may improve the ability to detect patients at high risk for progression to diabetes.
“Few studies have prospectively compared the difference in progression to diabetes using the new HbA1c criterion and existing IFG,” Yoriko Heianza, RD, of the University of Tsukuba Mito and the Toranomon Hospital in Japan, said at the Joint ADA/The Lancet Symposium. “It has also not yet been quantified whether introducing in addition to IFG could effectively target people most likely to develop diabetes.”
Heianza and colleagues conducted the longitudinal Toranomon Hospital Health Management Center Study (TOPICS 3) to assess the diagnosis of prediabetes and progression rates to full-blown diabetes via HbA1c criterion alone, IFG alone and both tests. The current analysis included 6,241 patients (mean age, 50 years; mean BMI, 23) who were examined every year for 4 to 5 years, Heianza said.
“Of the total individuals who were prediabetic at baseline, only 20% were classified as having prediabetes by the new HbA1c criterion without IFG,” Heianza said. “The important point is that screening by HbA1c alone missed 61% of the total prediabetes diagnoses made by a combination of IFG and the HbA1c criterion.”
Results demonstrated no significant difference in progression to diabetes between patients who were diagnosed with prediabetes according to HbA1c (7%) or IFG (9%) alone. Diagnosis of prediabetes with either method was also predictive of 86% of newly diagnosed cases of diabetes in the cohort, the researchers said.
The risk for newly diagnosed diabetes was comparably higher among patients with prediabetes detected by HbA1c alone (adjusted HR=6; 95% CI, 3.76-9.56) or IFG alone (HR=6.16; 95% CI, 4.33-8.77). This risk, however, increased substantially when prediabetes was identified through both measures, with the HR escalating to 31.9 (95% CI, 22.6-45), as compared with normoglycemic individuals.
“These results have the potential to reduce incidence of diabetes by allowing such individuals to undertake strategies to prevent progression to type 2 diabetes,” Heianza said.
Anoop Misra, MD, of Fortis Hospital in New Delhi, India, and Satish Garg, MD, of the Barbara Davis Center for Childhood Diabetes at the University of Colorado Denver, noted that using both screening methods would be costly. Further, they explained that implementing a combined method would classify millions of previously health adults as prediabetic.
“In those countries that could afford such tests, the use of blood glucose and HbA1c together (especially with the availability of point-of-care standardized testing), as shown by Heianza and co-workers, would identify many more at risk for diabetes and even cardiovascular disease,” they wrote in an editorial published in The Lancet. “We believe it is better to cover a larger segment of people with preventive lifestyle advice to prevent future risk for diabetes, but this conclusion requires large-scale longitudinal studies.” – by Melissa Foster
For more information:
- Heianza Y. Joint ADA/The Lancet Symposium: Presented at: American Diabetes Association’s 71st Scientific Sessions; June 24-28, 2011; San Diego, Calif.
- Heianza Y. Lancet. 2011;doi:10.1016/S0140-6736(11)60472-8.
- Misra A. Lancet. 2011;doi:10.1016/S0140-6736(11)60789-7.
Disclosure: Drs. Heianza, Misra and Garg report no relevant financial disclosures.
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