About this item:

677 Views | 692 Downloads

Author Notes:

Corresponding author: Darin E. Olson, deolson@emory.edu

D.E.O. devised the research questions, formulated the research plan, researched data, and wrote the manuscript. M.K.R. devised the research questions, formulated the research plan, researched data, and reviewed/edited the manuscript.

K.H. researched data and reviewed/edited the manuscript.

D.C.Z. devised the research questions, formulated the research plan, and researched data.

J.G.T. devised the research questions, formulated the research plan, and reviewed/edited the manuscript.

L.S.P. devised the research questions, formulated the research plan, oversaw all research of data, wrote the manuscript, and reviewed/edited the manuscript.

No potential conflicts of interest relevant to this article were reported.


Research Funding:

This work was supported in part by National Institutes of Health (awards DK-066204, 5K23-DK-070715, and T32-DK-007298) and Veterans Administration (VA Health Services Research and Development award IIR 07-138).

Screening for Diabetes and Pre-Diabetes With Proposed A1C-Based Diagnostic Criteria


Journal Title:

Diabetes Care


Volume 33, Number 10


, Pages 2184-2189

Type of Work:

Article | Final Publisher PDF


OBJECTIVE An International Expert Committee (IEC) and the American Diabetes Association (ADA) proposed diagnostic criteria for diabetes and pre-diabetes based on A1C levels. We hypothesized that screening for diabetes and pre-diabetes with A1C measurements would differ from using oral glucose tolerance tests (OGTT). RESEARCH DESIGN AND METHODS We compared pre-diabetes, dysglycemia (diabetes or pre-diabetes), and diabetes identified by the proposed criteria (A1C ≥6.5% for diabetes and 6.0–6.4% [IEC] or 5.7–6.4% [ADA] for high risk/pre-diabetes) with standard OGTT diagnoses in three datasets. Non-Hispanic white or black adults without known diabetes who had A1C and 75-g OGTT measurements were included from the prospective Screening for Impaired Glucose Tolerance study (n = 1,581), and from the National Health and Nutrition Examination Survey (NHANES) III (n = 2014), and NHANES 2005–2006 (n = 1,111). RESULTS OGTTs revealed pre-diabetes in 35.8% and diabetes in 5.2% of combined study subjects. A1C provided receiver operating characteristic (ROC) curve areas for diabetes of 0.79–0.83, but ROC curve areas were ≤0.70 for dysglycemia or pre-diabetes. The proposed criteria missed 70% of individuals with diabetes, 71–84% with dysglycemia, and 82–94% with pre-diabetes. Compared with the IEC criteria, the ADA criteria for pre-diabetes resulted in fewer false-negative and more false-positive result. There were also racial differences, with false-positive results being more common in black subjects and false-negative results being more common in white subjects. With use of NHANES 2005–2006 data, ∼5.9 million non-Hispanic U.S. adults with unrecognized diabetes and 43–52 million with pre-diabetes would be missed by screening with A1C. CONCLUSIONS The proposed A1C diagnostic criteria are insensitive and racially discrepant for screening, missing most Americans with undiagnosed diabetes and pre-diabetes.

Copyright information:

© 2010 by the American Diabetes Association

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommerical-NoDerivs 3.0 Unported License (http://creativecommons.org/licenses/by-nc-nd/3.0/).

Creative Commons License

Export to EndNote