Test Performance Of HbA1c Compared To Fasting Plasma Glucose ...

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Abstract

The prevalence of diabetes in Singapore is high. Screening to facilitate early detection and intervention has been shown to be cost-effective. Current clinical practice guidelines in Singapore recommend screening with fasting plasma glucose (FPG), followed by an oral glucose tolerance test (OGTT) in those with FPG 6.1-6.9 mmol/L. Glycated haemoglobin A1c (HbA1c) has robust stability at ambient temperature, and can be performed on non-fasted capillary blood samples, making it an attractive potential alternative for screening. However, limitations of HbA1c include differential performance in different races, and its performance as a screening test has not been well characterized in Asian populations. This study compares HbA1c and FPG as diabetes screening modalities in 3540 community-dwelling Singapore residents of Chinese, Malay and Indian race to detect diabetes mellitus diagnosed based on blood glucose (FPG ≥ 7.0 mmol/L, 2 hr OGTT ≥ 11.1 mmol/L). The area under the receiver-operating-characteristic curve (AUC) was higher for FPG compared to HbA1c in the overall population and age, race and age-race strata, but these differences were not statistically significant. HbA1c > = 7.0% identified 95% of individuals with diabetes mellitus, and the remainder had impaired glucose tolerance (IGT). HbA1c cut-off at 6.1% had better sensitivity (0.825) to FPG at 6.1 mmol/L. The positive predictive value of HbA1c at 6.1% was 40-50% in different age-race combinations with a negative predictive value of about 98%. If follow-up screening with FPG is used, a lower cut-off at 5.6 mmol/L is appropriate in identifying people with pre-diabetes, as about 85% of people with HbA1c 6.1-6.9% and FPG 5.6-6.9 mmol/L had IFG/IGT or diabetes in the study sample. HbA1c is an appropriate alternative to FPG as a first-step screening test, and the combination of Hba1c > = 6.1% and FPG > = 5.6 mmol/L would improve the identification of individuals with diabetes mellitus and prediabetes.

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Figures

Figure 1

Receiver operating characteristic (ROC) curves…

Figure 1

Receiver operating characteristic (ROC) curves for HbA1c and FPG in all study participants.

Figure 2

Receiver operating characteristic (ROC) curves…

Figure 2

Receiver operating characteristic (ROC) curves for HbA1c and fasting plasma glucose (FPG) in…

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References

1. 1. DB Sacks. A1C Versus Glucose Testing: A Comparison. Diabetes Care. 34, 518–523 (2011). - PMC - PubMed
2. 1. Ministry of Health Malaysia 2015. Clinical practice Guidelines: Management of Type 2 Diabetes mellitus5th edition. http://www.moh.gov.my/penerbitan/CPG/CPG%20T2DM%202015.pdf [Last accessed: 6 June 2018].
3. 1. Ministry of Health New Zealand 2011. Guidance on the management of Type 2 Diabetes. http://www.moh.govt.nz/notebook/nbbooks.nsf/0/60306295DECB0BC6CC257A4F00... [Last accessed: 6 June 2018].
4. 1. Ministry of Health Singapore 2014. MOH Clinical Practice Guidelines 1/2014 Diabetes mellitus. https://www.moh.gov.sg/content/dam/moh_web/HPP/Doctors/cpg_medical/curre... [Last accessed: 6 June 2018].
5. 1. Venkataraman K, et al. Ethnicity modifies the relation between fasting plasma glucose and HbA1c in Indians, Malays and Chinese. Diabet Med. 2012;29:911–917. doi: 10.1111/j.1464-5491.2012.03599.x. - DOI - PMC - PubMed

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