Acta Diabetologica

, Volume 50, Issue 6, pp 837–842

Optimal HbA1c cutoff for detecting diabetic retinopathy

  • Nam H. Cho
  • Tae Hyuk Kim
  • Se Joon Woo
  • Kyu Hyung Park
  • Soo Lim
  • Young Min Cho
  • Kyong Soo Park
  • Hak C. Jang
  • Sung Hee Choi
Original Article


The associations between high glucose levels and diabetic retinopathy have been the basis for the diagnosis of diabetes. We aimed to provide updated data on the relationship between HbA1c and diabetic retinopathy, and to assess the diagnostic accuracy of the proposed HbA1c cutoff for detecting diabetic retinopathy. This cross-sectional study included 3,403 adults from the 2009 to 2010 Ansung Cohort Study. Retinopathy was assessed with single-field nonmydriatic fundus photography and graded according to the International Clinical Diabetic Retinopathy Disease Severity Scale. HbA1c was measured by standardized assay using high performance liquid chromatography. Based on deciles distribution, the prevalence of retinopathy was very low until the HbA1c range of 48–51 mmol/mol (6.5–6.8 %). The optimal HbA1c cutoff for detecting any diabetic retinopathy was 49 mmol/mol (6.6 %), moderate or severer retinopathy was 52 mmol/mol (6.9 %) from receiver operating characteristic curve analysis. The proposed HbA1c threshold of 48 mmol/mol (6.5 %) from American Diabetes Association produced comparable accuracy for identifying both any and moderate/severer retinopathy. This study confirmed that the proposed HbA1c threshold of 48 mmol/mol (6.5 %) allowed the proper detection of diabetic retinopathy. Our data support the judicious use of HbA1c for the diagnosis of diabetes and detecting diabetic retinopathy as well.


Diabetes Epidemiology Diagnosis HbA1c Retinopathy 


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Copyright information

© Springer-Verlag Italia 2013

Authors and Affiliations

  • Nam H. Cho
    • 1
  • Tae Hyuk Kim
    • 2
  • Se Joon Woo
    • 3
  • Kyu Hyung Park
    • 3
  • Soo Lim
    • 2
    • 4
  • Young Min Cho
    • 2
  • Kyong Soo Park
    • 2
  • Hak C. Jang
    • 2
    • 4
  • Sung Hee Choi
    • 2
    • 4
  1. 1.Department of Preventive MedicineAjou University School of MedicineSuwonSouth Korea
  2. 2.Department of Internal MedicineSeoul National University College of MedicineSeoulSouth Korea
  3. 3.Department of Ophthalmology, Seoul National University College of MedicineSeoul National University Bundang HospitalSeongnamSouth Korea
  4. 4.Department of Internal MedicineSeoul National University Bundang HospitalSeongnamSouth Korea

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