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Acta Diabetologica

, Volume 53, Issue 4, pp 543–550 | Cite as

The 1-hour post-load glucose level is more effective than HbA1c for screening dysglycemia

  • Ram Jagannathan
  • Mary Ann Sevick
  • Dorothy Fink
  • Rachel Dankner
  • Angela Chetrit
  • Jesse Roth
  • Martin Buysschaert
  • Michael BergmanEmail author
Original Article

Abstract

Aim

To assess the performance of HbA1c and the 1-h plasma glucose (PG ≥ 155 mg/dl; 8.6 mmol/l) in identifying dysglycemia based on the oral glucose tolerance test (OGTT) from a real-world clinical care setting.

Methods

This was a diagnostic test accuracy study. For this analysis, we tested the HbA1c diagnostic criteria advocated by the American Diabetes Association (ADA 5.7–6.4 %) and International Expert Committee (IEC 6.0–6.4 %) against conventional OGTT criteria. We also tested the utility of 1-h PG ≥ mg/dl; 8.6 mmol/l. Prediabetes was defined according to ADA-OGTT guidelines. Spearman correlation tests were used to determine the relationships between HbA1c, 1-h PG with fasting, 2-h PG and indices of insulin sensitivity and β-cell function. The levels of agreement between diagnostic methods were ascertained using Cohen’s kappa coefficient (Κ). Receiver operating characteristic (ROC) curve was used to analyze the performance of the HbA1c and 1-h PG test in identifying prediabetes considering OGTT as reference diagnostic criteria. The diagnostic properties of different HbA1c thresholds were contrasted by determining sensitivity, specificity and likelihood ratios (LR).

Results

Of the 212 high-risk individuals, 70 (33 %) were identified with prediabetes, and 1-h PG showed a stronger association with 2-h PG, insulin sensitivity index, and β-cell function than HbA1c (P < 0.05). Furthermore, the level of agreement between 1-h PG ≥ 155 mg/dl (8.6 mmol/l) and the OGTT (Κ[95 % CI]: 0.40[0.28–0.53]) diagnostic test was stronger than that of ADA-HbA1c criteria 0.1[0.03–0.16] and IEC criteria (0.17[0.04–0.30]). The ROC (AUC[95 % CI]) for HbA1c and 1-h PG were 0.65[0.57–0.73] and 0.79[0.72–0.85], respectively. Importantly, 1-h PG ≥ 155 mg/dl (8.6 mmol/l) showed good sensitivity (74.3 % [62.4–84.0]) and specificity 69.7 % [61.5–77.1]) with a LR of 2.45. The ability of 1-h PG to discriminate prediabetes was better than that of HbA1c (∆AUC: −0.14; Z value: 2.5683; P = 0.01022).

Conclusion

In a real-world clinical practice setting, the 1-h PG ≥ 155 mg/dl (8.6 mmol/l) is superior for detecting high-risk individuals compared with HbA1c. Furthermore, HbA1c is a less precise correlate of insulin sensitivity and β-cell function than the 1-h PG and correlates poorly with the 2-h PG during the OGTT.

Keywords

HbA1c OGTT Dysglycemia Prediabetes 1-hour post-load glucose Diabetes prevention 

Notes

Acknowledgments

This study was funded by CTSI Grant Number 1UL1RR029893 (NCRR, NIH, and the Schuman Foundation) and partly by NIH-K24-NR012226.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

This study was approved by the New York University School of Medicine Institutional Review Board.

Human and animal rights disclosure

All human rights were observed in keeping with Declaration of Helsinki 2008 (ICH GCP). There are no animal rights issues as this is a clinical study.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer-Verlag Italia 2016

Authors and Affiliations

  • Ram Jagannathan
    • 1
  • Mary Ann Sevick
    • 1
  • Dorothy Fink
    • 2
  • Rachel Dankner
    • 3
    • 4
    • 5
  • Angela Chetrit
    • 3
  • Jesse Roth
    • 4
  • Martin Buysschaert
    • 6
  • Michael Bergman
    • 2
    Email author
  1. 1.NYU School of Medicine, Department of Population HealthCenter for Healthful Behavior ChangeNew YorkUSA
  2. 2.NYU School of Medicine, Department of Medicine, Division of Endocrinology and MetabolismNYU Langone Diabetes Prevention ProgramNew YorkUSA
  3. 3.Unit for Cardiovascular Epidemiology, The Gertner Institute for Epidemiology and Health Policy ResearchSheba Medical CenterTel HashomerIsrael
  4. 4.The Feinstein Institute for Medical ResearchNorth ShoreUSA
  5. 5.Sackler Faculty of Medicine, School of Public Health, Department of Epidemiology and Preventive MedicineTel Aviv UniversityTel AvivIsrael
  6. 6.Service d’Endocrinologie et Nutrition Cliniques Universitaires St-LucUniversité Catholique de LouvainBrusselsBelgium

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