HbA1c Cutoff Point of 5.9% Better Identifies High Risk of Progression to Diabetes among Chinese Adults: Results from a Retrospective Cohort Study
Aims. This article performed a retrospective cohort study to estimate the annual incidence rates of diabetes and to assess the utility of HbA1c as a predictor for progression to diabetes in Chinese community adults aged 40 years or older. Methods. In all, 2778 nondiabetic subjects (including 1901 wo...
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| Format: | Article |
| Language: | English |
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Wiley
2018-01-01
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| Series: | Journal of Diabetes Research |
| Online Access: | http://dx.doi.org/10.1155/2018/7486493 |
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| author | Kai Liang Chuan Wang Fei Yan Lingshu Wang Tianyi He Xiuping Zhang Chengqiao Li Weifang Yang Zeqiang Ma Aixia Ma Xinguo Hou Li Chen |
| author_facet | Kai Liang Chuan Wang Fei Yan Lingshu Wang Tianyi He Xiuping Zhang Chengqiao Li Weifang Yang Zeqiang Ma Aixia Ma Xinguo Hou Li Chen |
| author_sort | Kai Liang |
| collection | DOAJ |
| description | Aims. This article performed a retrospective cohort study to estimate the annual incidence rates of diabetes and to assess the utility of HbA1c as a predictor for progression to diabetes in Chinese community adults aged 40 years or older. Methods. In all, 2778 nondiabetic subjects (including 1901 women) underwent HbA1c testing and oral glucose tolerance test (OGTT) measurements at baseline and after 3 years. Diabetes and prediabetes were defined using the WHO criteria. The HbA1c cutoff points were evaluated to predict the future risks of diabetes. Relative risk (RR) was calculated using the chi-square test. The area under the receiver operating characteristic (ROC) curve (AUC) was used to evaluate the predictive efficiency of fasting plasma glucose (FPG), 2 hr postprandial plasma glucose (2hPG), and HbA1c for progression to diabetes. A superior cutoff point was defined as the point on the ROC curve with a larger Youden index. Results. Overall, 7.5% (210/2778) of the subjects progressed to diabetes, yielding an annual 2.5% diabetes incidence rate. Additionally, 4.5% (100/2227) of the subjects with normal glucose tolerance (NGT) and 19.6% (110/561) of the subjects with prediabetes progressed to diabetes, and the relative risk of progression to diabetes was 5.188 times higher in subjects with prediabetes than in subjects with NGT (p<0.001). Compared to subjects with HbA1c values ≤ 5.6%, the RRs of progression to diabetes in subjects whose HbA1c ranged from 5.7 to 5.8%, 5.9 to 6.2%, 6.3 to 6.4%, and ≥6.5% were 1.165, 2.582, 5.732, and 16.619, respectively. However, the RRs for subjects with HbA1c ranging from 5.7 to 5.8% and those with HbA1c ≤ 5.6% did not differ significantly (p=0.615). The AUCs for predicting diabetes after 3 years by FPG, 2hPG, and HbA1c were 0.752 (95% confidence interval 0.718–0.787), 0.710 (95% confidence interval 0.671–0.748), and 0.756 (95% confidence interval 0.720–0.793), respectively. The HbA1c cutoff point of 5.9% (sensitivity of 0.771 and specificity of 0.580) may better identify individuals at high risk of progression to diabetes than the 5.7% value (sensitivity of 0.862 and specificity of 0.371) due to the former’s larger Youden index of 0.351, which exceeded the indices for FPG and 2hPG. Conclusions. The use of HbA1c values ≥ 5.9% may provide greater accuracy in evaluating the risk of progression to diabetes and identify individuals with prediabetes with greater reliability among Chinese adults. |
| format | Article |
| id | doaj-art-d870cf5639034062a1e49f6d4d4eee9d |
| institution | Kabale University |
| issn | 2314-6745 2314-6753 |
| language | English |
| publishDate | 2018-01-01 |
| publisher | Wiley |
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| series | Journal of Diabetes Research |
| spelling | doaj-art-d870cf5639034062a1e49f6d4d4eee9d2025-02-03T06:07:16ZengWileyJournal of Diabetes Research2314-67452314-67532018-01-01201810.1155/2018/74864937486493HbA1c Cutoff Point of 5.9% Better Identifies High Risk of Progression to Diabetes among Chinese Adults: Results from a Retrospective Cohort StudyKai Liang0Chuan Wang1Fei Yan2Lingshu Wang3Tianyi He4Xiuping Zhang5Chengqiao Li6Weifang Yang7Zeqiang Ma8Aixia Ma9Xinguo Hou10Li Chen11Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, ChinaDepartment of Endocrinology, Qilu Hospital of Shandong University, Jinan, ChinaDepartment of Endocrinology, Qilu Hospital of Shandong University, Jinan, ChinaDepartment of Endocrinology, Qilu Hospital of Shandong University, Jinan, ChinaDepartment of Endocrinology, Qilu Hospital of Shandong University, Jinan, ChinaShantui Community Health Center, Jining, ChinaDepartment of Endocrinology, Second People's Hospital, Jining, ChinaLukang Hospital, Jining, ChinaChina National Heavy-Duty Truck Group Corporation Hospital, Jinan, ChinaDepartment of Endocrinology, Qilu Hospital of Shandong University, Jinan, ChinaDepartment of Endocrinology, Qilu Hospital of Shandong University, Jinan, ChinaDepartment of Endocrinology, Qilu Hospital of Shandong University, Jinan, ChinaAims. This article performed a retrospective cohort study to estimate the annual incidence rates of diabetes and to assess the utility of HbA1c as a predictor for progression to diabetes in Chinese community adults aged 40 years or older. Methods. In all, 2778 nondiabetic subjects (including 1901 women) underwent HbA1c testing and oral glucose tolerance test (OGTT) measurements at baseline and after 3 years. Diabetes and prediabetes were defined using the WHO criteria. The HbA1c cutoff points were evaluated to predict the future risks of diabetes. Relative risk (RR) was calculated using the chi-square test. The area under the receiver operating characteristic (ROC) curve (AUC) was used to evaluate the predictive efficiency of fasting plasma glucose (FPG), 2 hr postprandial plasma glucose (2hPG), and HbA1c for progression to diabetes. A superior cutoff point was defined as the point on the ROC curve with a larger Youden index. Results. Overall, 7.5% (210/2778) of the subjects progressed to diabetes, yielding an annual 2.5% diabetes incidence rate. Additionally, 4.5% (100/2227) of the subjects with normal glucose tolerance (NGT) and 19.6% (110/561) of the subjects with prediabetes progressed to diabetes, and the relative risk of progression to diabetes was 5.188 times higher in subjects with prediabetes than in subjects with NGT (p<0.001). Compared to subjects with HbA1c values ≤ 5.6%, the RRs of progression to diabetes in subjects whose HbA1c ranged from 5.7 to 5.8%, 5.9 to 6.2%, 6.3 to 6.4%, and ≥6.5% were 1.165, 2.582, 5.732, and 16.619, respectively. However, the RRs for subjects with HbA1c ranging from 5.7 to 5.8% and those with HbA1c ≤ 5.6% did not differ significantly (p=0.615). The AUCs for predicting diabetes after 3 years by FPG, 2hPG, and HbA1c were 0.752 (95% confidence interval 0.718–0.787), 0.710 (95% confidence interval 0.671–0.748), and 0.756 (95% confidence interval 0.720–0.793), respectively. The HbA1c cutoff point of 5.9% (sensitivity of 0.771 and specificity of 0.580) may better identify individuals at high risk of progression to diabetes than the 5.7% value (sensitivity of 0.862 and specificity of 0.371) due to the former’s larger Youden index of 0.351, which exceeded the indices for FPG and 2hPG. Conclusions. The use of HbA1c values ≥ 5.9% may provide greater accuracy in evaluating the risk of progression to diabetes and identify individuals with prediabetes with greater reliability among Chinese adults.http://dx.doi.org/10.1155/2018/7486493 |
| spellingShingle | Kai Liang Chuan Wang Fei Yan Lingshu Wang Tianyi He Xiuping Zhang Chengqiao Li Weifang Yang Zeqiang Ma Aixia Ma Xinguo Hou Li Chen HbA1c Cutoff Point of 5.9% Better Identifies High Risk of Progression to Diabetes among Chinese Adults: Results from a Retrospective Cohort Study Journal of Diabetes Research |
| title | HbA1c Cutoff Point of 5.9% Better Identifies High Risk of Progression to Diabetes among Chinese Adults: Results from a Retrospective Cohort Study |
| title_full | HbA1c Cutoff Point of 5.9% Better Identifies High Risk of Progression to Diabetes among Chinese Adults: Results from a Retrospective Cohort Study |
| title_fullStr | HbA1c Cutoff Point of 5.9% Better Identifies High Risk of Progression to Diabetes among Chinese Adults: Results from a Retrospective Cohort Study |
| title_full_unstemmed | HbA1c Cutoff Point of 5.9% Better Identifies High Risk of Progression to Diabetes among Chinese Adults: Results from a Retrospective Cohort Study |
| title_short | HbA1c Cutoff Point of 5.9% Better Identifies High Risk of Progression to Diabetes among Chinese Adults: Results from a Retrospective Cohort Study |
| title_sort | hba1c cutoff point of 5 9 better identifies high risk of progression to diabetes among chinese adults results from a retrospective cohort study |
| url | http://dx.doi.org/10.1155/2018/7486493 |
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