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Prediabetes defined by HbA1c and by fasting glucose: differences in risk factors and prevalence

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Abstract

Aims

To investigate, in a sample of nondiabetic adults from a Spanish community, the differences between prediabetes as defined by HbA1c (“H-prediabetes”) and by fasting plasma glucose (FPG) (“F-prediabetes”) in regard to prevalence and the influence of potential risk factors, adjusting the latter for confounders.

Methods

A total of 1328 nondiabetic participants aged ≥ 18 years were classified as normoglycemic, H-prediabetic [HbA1c 5.7–6.4% (39–47 mmol/mol)] or F-prediabetic (FPG 5.6–6.9 mmol/L). Multivariable analyses were used to compare the impacts of risk factors on the prevalence of H-prediabetes, F-prediabetes and their conjunctive and disjunctive combinations (“HaF-prediabetes” and “HoF-prediabetes,” respectively).

Results

Some 29.9% of participants were HoF-prediabetic, 21.7% H-prediabetic, 16.3% F-prediabetic and only 8.1% HaF-prediabetic. Whatever the definition of prediabetes, increasing age, fasting insulin and LDL cholesterol were each a risk factor after adjustment for all other variables. Increasing BMI and decreasing mean corpuscular hemoglobin (MCH) were additional risk factors for H-prediabetes; male sex and increasing uric acid for F-prediabetes and increasing BMI for HaF-prediabetes. The participants satisfying the compound condition “hypertension or hyperlipidemia or obesity or hyperuricemia” (59.9% of the whole study group) included 83.1% of all subjects with HoF-prediabetes.

Conclusions

In this population, the most sensitive risk factor for detection of prediabetes was age, followed by fasting insulin, LDL cholesterol, BMI, MCH, male sex and uric acid, with differences depending on the definition of prediabetes. MCH, an indirect measure of erythrocyte survival, significantly influences the prevalence of HbA1c-defined prediabetes. This study suggests that screening of individuals with selected risk factors may identify a high proportion of prediabetic persons.

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Abbreviations

ADA:

American Diabetes Association

AEGIS:

The A Estrada Glycation and Inflammation Study

CI:

Confidence interval

FPG:

Fasting plasma glucose

F-prediabetes:

Prediabetes according to the FPG criterion (FPG 5.6–6.9 mmol/L)

GMA drugs:

Pharmaceutical drugs affecting glucose metabolism

HbA1c :

Glycated hemoglobin

H-prediabetes:

Prediabetes according to the HbA1c criterion [HbA1c 39–46 mmol/mol (5.7–6.4%)]

HaF-prediabetes:

Prediabetes according to both the FPG and HbA1c criteria

HoF-prediabetes:

Prediabetes according either the HbA1c or the FPG criterion, or both

IFG:

Impaired fasting glucose

OGTT:

Oral glucose tolerance test

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Acknowledgements

The authors wish to thank the people of the northwest-Spanish municipality of A Estrada who agreed to participate in this study.

Funding

This research project was supported by Spain´s Carlos III Institute of Health through research Grants PI16/01395, PI13/02594 and PI11/02219, and through networking grants in relation to its Preventive Activity & Health Promotion Research Network (RD12/0005/0007 and RD16/0007/0006) and Addictive Disorders Network (RD16/0017/0018), in all cases with cofunding from FEDER funds and by a grant from the Xunta de Galicia in relation to its INBIOEST network (ED341D R2016/032).

Author information

Authors and Affiliations

  1. Department of Biochemistry and Molecular Biology, University of Santiago de Compostela, 15782, Santiago de Compostela, Spain

    Santiago Rodriguez-Segade, Javier Rodriguez & Félix Camiña

  2. Clinical Biochemistry Laboratory, Complejo Hospitalario Universitario de Santiago, Travesía de la Choupana s/n, 15706, Santiago de Compostela, Spain

    Santiago Rodriguez-Segade & Javier Rodriguez

  3. Primary Care Center, 36800, A-Estrada, Pontevedra, Spain

    Luís Sanmartín-Portas & Josefa Gerpe-Jamardo

  4. Division of Endocrinology, Complejo Hospitalario Universitario de Santiago, Travesía de Conxo s/n, 15706, Santiago de Compostela, Spain

    Marcos Pazos-Couselo & Jose M. García-López

  5. Clinical Epidemiology Unit, Complejo Hospitalario Universitario de Santiago, Travesía de la Choupana s/n, 15706, Santiago de Compostela, Spain

    Manuela Alonso-Sampedro & Francisco Gude

  6. Division of Internal Medicine, School of Medicine, University of Santiago de Compostela, c/San Francisco n-1, 15782, Santiago de Compostela, Spain

    Manuela Alonso-Sampedro & Arturo González-Quintela

Authors
  1. Santiago Rodriguez-Segade
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  2. Javier Rodriguez
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  3. Félix Camiña
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  4. Luís Sanmartín-Portas
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  6. Marcos Pazos-Couselo
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  7. Jose M. García-López
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  8. Manuela Alonso-Sampedro
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  9. Arturo González-Quintela
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  10. Francisco Gude
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Contributions

Dr. Santiago Rodriguez-Segade is the guarantor of this work and, as such, had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. SRS designed, researched and wrote the manuscript. JR, LSP, JGJ, MPC JMGL, MAS, ALQ and FG research data and contributed to discussion. FC contributed to discussion, edited the manuscript and made artwork. The final version of the manuscript was approved by all authors.

Corresponding author

Correspondence to Santiago Rodriguez-Segade.

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Conflict of interest

The authors declare that there is no duality of interest associated with this manuscript.

Ethical approval

The study was reviewed and approved by the clinical research ethics committee of Galicia, Spain (CEIC 2012-025) and conformed with the current Helsinki Declaration.

Informed consent

Written informed consent was obtained from each participant.

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Rodriguez-Segade, S., Rodriguez, J., Camiña, F. et al. Prediabetes defined by HbA1c and by fasting glucose: differences in risk factors and prevalence. Acta Diabetol 56, 1023–1030 (2019). https://doi.org/10.1007/s00592-019-01342-5

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  • DOI: https://doi.org/10.1007/s00592-019-01342-5

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