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Low positive predictive value of hemoglobin A1c for diagnosis of prediabetes in clinical practice.

AbstractBACKGROUND:
Positive predictive value (PPV) of hemoglobin A1c (HbA1c) for diagnosis of prediabetes in clinical practice has not been well studied.
METHODS:
In a prospective study, patients diagnosed with prediabetes based on HbA1c (5.7%-6.4%) underwent a 75-g oral glucose tolerance test (OGTT) as the gold standard test to diagnose dysglycemia. Demographics, anthropometrics, comorbidity, concomitant prescription medications and biochemical data were collected.
RESULTS:
We identified 66 patients with HbA1c-based prediabetes with a mean HbA1c of 6.00 ± 0.20%. However, based on the OGTT, 32 had normal glucose tolerance (NGT), 26 had prediabetes and 8 had diabetes yielding a PPV of HbA1c of 39.4%. In univariate analysis, the patients with the OGTT-based prediabetes administered more medications for associated medical problems compared with the NGT group (5.9 ± 2.2 versus 2.6 ± 1.8, P < 0.0001). After adjustment for baseline variables, the medication use remained significantly different between OGTT-based prediabetes and NGT groups (P = 0.041).
CONCLUSIONS:
PPV of HbA1c for diagnosis of prediabetes in clinical setting is low. Patients with HbA1c of 5.7% to 6.4% should undergo OGTT to confirm diagnosis of dysglycemia.
AuthorsAidar R Gosmanov, Jim Wan
JournalThe American journal of the medical sciences (Am J Med Sci) Vol. 348 Issue 3 Pg. 191-4 (Sep 2014) ISSN: 1538-2990 [Electronic] United States
PMID24556928 (Publication Type: Journal Article)
Chemical References
  • Biomarkers
  • Blood Glucose
  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human
Topics
  • Adult
  • Aged
  • Biomarkers (blood)
  • Blood Glucose (metabolism)
  • Cross-Sectional Studies
  • Female
  • Glucose Tolerance Test (standards)
  • Glycated Hemoglobin (metabolism)
  • Humans
  • Male
  • Middle Aged
  • Prediabetic State (blood, diagnosis)
  • Predictive Value of Tests
  • Prospective Studies

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