(05-07-10) Hemoglobin A1c between 5.7 and 6.4% as a marker for identifying pre-diabetes, insulin sensitivity and secretion, and cardiovascular

Hemoglobin A1c between 5.7 and 6.4% as a marker for identifying pre-diabetes, insulin sensitivity and secretion, and cardiovascular risk factors: The Insulin Resistance Atherosclerosis Study (IRAS).

Lorenzo C, Wagenknecht LE, Hanley AJ, Rewers MJ, Karter AJ, Haffner SM.

1. Department of Medicine, University of Texas Health Science Center, San
Antonio, Texas.
Abstract
AbstractObjective: Hemoglobin A1c (A1C) is an optional method for diagnosing
diabetes and also for detecting individuals at increased risk of the disease.
However, how A1C compares with fasting (FPG) and 2-h plasma glucose (2-h PG)
for detecting at-risk individuals is not well-known. Methods: A two-hour
glucose tolerance test, frequently sampled intravenous glucose tolerance test,
and A1C were obtained in the follow-up examination in 855 participants in the
Insulin Resistance Atherosclerosis Study. For this report, 385 were at
increased risk of diabetes as defined by A1C between 5.7 and 6.4%, (A1C(5.7-
6.4%)), impaired glucose tolerance (IGT), and/or impaired fasting glucose
(IFG). Results: IFG and IGT identified 69.1% and 59.5% of all individuals at
increased risk of diabetes, respectively. A1C(5.7-6.4%) detected 23.6% of all
at-risk individuals, although more African Americans (31.4%) and Hispanics
(35.2%) than non-Hispanic whites (9.9%). Relative to A1C, FPG was more strongly
related to fasting insulin (r = 0.38 vs. 0.26, p <0.01), AIR (r = - 0.20 vs. -
0.09, p <0.01), and waist circumference (r = 0.43 vs. 0.25, p <0.001) by the
Spearman's correlation test. Similarly, 2-h PG was more strongly related to S
(I) (r = - 0.40 vs. - 0.27, p <0.01) and triglycerides (r = 0.30 vs. 0.08, p <0.
001). Conclusions: A1C(5.7-6.4%) is less sensitive for detecting at-risk
individuals than IFG and IGT, particularly among non-Hispanic whites. Single
determinations of FPG and 2-h PG appear more precise correlates of insulin
resistance and secretion than A1C and in general better for other metabolic
disorders.


Source: Diabetes Care. 2010 Jun 23. [Epub ahead of print]

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