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Impact of glycated hemoglobin (HbA1c) on identifying insulin resistance among apparently healthy individuals

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Abstract

Aims

Insulin resistance has been implicated as a risk factor for metabolic disorders. Due to the clinical interest in insulin resistance, it is of great importance to develop a simple test that can be used in routine clinical settings for identifying insulin-resistant individuals in advance. Glycated hemoglobin (HbA1c) has been considered as a potentially good indicator of overall glycemic exposure and likely risk for long-term complications. Therefore, this study is designed to investigate the importance of HbA1c in predicting insulin resistance among apparently healthy at-risk German populations.

Methods

The association between HbA1c and several surrogate markers of insulin resistance/sensitivity based on plasma glucose and insulin concentrations was analyzed by bivariate correlation along with multivariate linear regression and receiver-operating characteristic curve analysis among normal (NGT) and impaired glucose tolerance (IGT) individuals (n = 3578 aged >18 years) in Germany.

Results

Spearman’s correlation coefficients showed that HbA1c had a significant association with insulin resistance/sensitivity markers in both NGT and IGT individuals and that this was stronger in the younger age group (<50 years) (rho = 0.410 with HOMA-IR, rho = −0.379 with the Matsuda index). Moreover, the ROC curve also showed that the HbA1c occupied a significant area under the curve (0.731 with 95% CI 0.661–0.801) and that the cutoff point for estimating insulin resistance corresponded to 5.8% (40 mmol/mol) with 34% sensitivity and 80% specificity.

Conclusion

From this study, it could be concluded that HbA1c may be a clinically useful and simple index for predicting the concomitant presence of insulin resistance and dysglycemia among apparently healthy, young (<50 years) German populations.

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Acknowledgments

The authors would like to thank Patrick Timpel for his careful reading of the manuscript.

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Authors and Affiliations

Authors

Contributions

S.S. analyzed the data and wrote the manuscript. P.S. reviewed and edited the manuscript.

Corresponding author

Correspondence to Peter E. H. Schwarz.

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Conflict of interest statement

The authors state that there is no conflict of interest and they have nothing to declare.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institution, the Technical University of Dresden.

Informed consent

Written informed consent was obtained from all individuals according to the guidelines of the Institutional Review Board for Human Studies at the Technical University of Dresden.

Additional information

Main messages of the article

1. The aim of this study was to investigate the role of HbA1c in predicting insulin resistance among apparently healthy individuals.

2. The study shows that HbA1c has a significant association with insulin resistance markers among young IGT individuals.

3. The ROC curve also demonstrates that HbA1c occupied a significant area under the curve (0.731 with 95% CI 0.661–0.801). Hence, HbA1c may be considered as a clinically useful and simple index for predicting the concomitant presence of insulin resistance and dysglycemia among apparently healthy young German populations (<50 years).

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Saha, S., Schwarz, P.E.H. Impact of glycated hemoglobin (HbA1c) on identifying insulin resistance among apparently healthy individuals. J Public Health 25, 505–512 (2017). https://doi.org/10.1007/s10389-017-0805-4

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