Exploration of differences of fasting-glucose, 2-hours oral glucose tolerance, and HbA1c Levels for prediabetes and T2 diabetes from the D-CLIP study Público
Costello, Casey (Spring 2020)
Abstract
AIMS:
Provide additional insight at to the utility of common diagnostic and screening methods for prediabetes and T2DM: fasting plasma glucose, oral glucose tolerance, and HbA1c, in an urban Indian population.
METHODS:
The prevalence of prediabetes and type 2 diabetes by HbA1c, fasting glucose, and 2 h glucose was compared in 1,285 participants from Chennai, India from the community screening for the D-CLIP Study. T2DM and prediabetes were classified by fasting plasma glucose, 2-hour plasma glucose, and HbA1c measures from the clinic-based screening using the American Diabetes Association criteria. Characteristics were compared across prediabetes and diabetes strata diagnosed by differing glycemic measures. Polytomous logistic regression models compared the odds of prediabetes or diabetes by each diagnostic criteria and assessing the association of demographic, behavioral, biochemical, and anthropometric covariates.
RESULTS:
743 individuals were identified with prediabetes, 23.8% by A1c only, 7.3% by 2-hour glucose only, and 6.7% by fasting glucose only. 380 individuals were diagnosed with T2DM, 32.6% by A1c only, 15.8% by 2-hour glucose only, and 2.1% by fasting glucose only. After adjusting for all covariates of interest, HOMA-IR was significantly associated with prediabetes by isolated A1c (OR: 1.21, 95% CI: 1.001-1.47), fasting glucose (OR:1.46, 95% CI: 1.17-1.83), and 2-hour glucose (OR: 1.46, 95% CI: 1.17-1.82), and HOMA-B was significantly associated with prediabetes by isolated fasting glucose (OR: 0.99, 95% CI: 0.984-0.997) and 2-hour glucose (OR: 1.005; 95% CI: 1.001-1.01). After adjusting for all covariates, there was a significant association between HOMA-IR and T2DM by isolated 2-hour glucose (OR: 1.21, 95% CI: 1.10-1.35) and with isolated A1c (OR: 1.11, 95% CI: 1.01-1.23), and HOMA-B and T2DM by isolated A1c (OR: 0.995, 95% CI: 0.991-0.998) and isolated fasting glucose (OR: 0.97, 95% CI: 0.94-0.99).
CONCLUSIONS:
With these results, there is not enough compelling evidence to use A1c as the primary test for identifying prediabetes or T2DM in Indian populations. In this population, the use of HbA1c for prediabetes and T2DM diagnosis could result in a higher prevalence, leading to mis- or over-diagnosis.
Table of Contents
Table of Contents
INTRODUCTION: 1
LITERATURE REVIEW: 4
METHODS: 12
STATISTICAL ANALYSIS 15
RESULTS: 16
Fig. 1 16
Fig. 2 16
Table 1. Clinical and Biochemical Characteristics of Participants Diagnosed with Prediabetes by isolated HbA1c, Fasting Glucose, and 2-hour Glucose Glycemic Status 18
Table 2. Clinical and Biochemical Characteristics of Participants Diagnosed with T2 DM by isolated HbA1c, Fasting Glucose, and 2-hour Glucose Glycemic Status 19
Table 3. Factors associated with prediabetes diagnosed by HbA1c, fasting glucose, and 2-hour glucose using multivariate regression 21
Table 4. Factors associated with T2 DM diagnosed by HbA1c, fasting glucose, and 2-hour glucose using multivariate regression 21
DISCUSSION: 22
APPENDIX: 29
Appendix A. 29
Appendix B. 30
Appendix C. 31
Appendix D. 31
Appendix E. 32
Appendix F. 33
REFERENCES: 34
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