Combination Screening Leads to Better Prediabetes Detection
Using a combination of hemoglobin A1C (HbA1C) and fasting plasma glucose (FPG) tests in screening for prediabetes reduces intrinsic systematic bias in using just HbA1C testing and offers the benefits of each test, according to a new study.
The researchers sought to determine combinations of blood glucose tests, including oral glucose tolerance (OGT), FPG, and HbA1C, associated with highest diagnostic rates of prediabetes in non-diabetic American children and adults.
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Approximately, 24 million Americans have type 2 diabetes, and more than 65 million others have prediabetes. Projections eye a 100% increase in prediabetes by 2030.
“Hence, accurate identification of people with prediabetes is imperative before applications of pharmacological and lifestyle interventions for the prevention and delay of type 2 diabetes,” the researchers said. “The application of a screening test that is both robust and handy is, therefore, vital for promptly ascertaining subjects with prediabetes. A robust and quick prediabetes diagnostic test can reduce overall societal costs of diabetes by motivating subjects with prediabetes to seek diabetes preventative care.”
Using the 2007-2008 U.S. National Health and Nutrition Examination Surveys, they found FPG + HbA1C associated with significantly higher diagnostic rates of prediabetes across age, race/ethnicity, and BMI. Estimates of overall prevalence of prediabetes using OGT + FPG, OGT + HbA1C, HbA1C + FPG, and OGT + FPG + HbA1C tests were 20.3%, 24.2%, 33%, and 34.3%, respectively.
Compared to OGT + FPG, HbA1C + FPG was associated with 44.8%, 135%, 38.6%, and 35.9% increased prevalence of prediabetes in non-Hispanic White, non-Hispanic Black, Mexican-American, and other racial/ethnic men, respectively. The corresponding values in women were 67.8%, 140%, 37.2%, and 42.6%, respectively.
“Combined use of all blood glucose tests did not improve the overall and gender-specific prediabetes prevalence beyond what was observed using HbA1C + FPG test,” they concluded, adding a well-defined HbA1C that takes into consideration race/ethnicity, gender, age, and BMI may improve prediabetes detection.
-Mike Bederka
Reference:
Okosun IS, Seale JP, Lyn R, Davis-Smith YM. Improving detection of prediabetes in children and adults: using combinations of blood glucose tests. Frontiers in Public Health November 2015. [epub ahead of print] doi: 10.3389/fpubh.2015.00260.