Reproducibility of a prediabetes classification in a contemporary population.

• Authors: Chhadvi Chadha, HealthPartners Institute for Education and Research; Anastassios G. Pittas, Tufts Medical Center; Christine W. Lary, Center for Outcomes Research and Evaluation; William C. Knowler, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ, USA.; Ranee Chatterjee, Duke University, Division of General Internal Medicine, 200 Morris Street, 3rd Floor, Durham, NC, 27701, USA.; Lawrence Phillips, Emory University; Vanita R. Aroda, MedStar Health Research Institute; Michael R. Lewis, University of Vermont; Richard Pratley, Advent Health Translational Research Institute for Metabolism and Diabetes; Myrlene A. Staten, National Institute of Diabetes and Digestive and Kidney Diseases; Jason Nelson, Tufts Medical Center; Neda Rasouli, University of Colorado; Irwin Brodsky, Maine Medical Partners Endocrinology and Diabetes Center, 175 US Route 1, Scarborough, ME, 04074, USA.
• Journal Title: Metabolism Open
• Volume: Volume 6
• Publisher: Elsevier Science Inc. | 2020-06, Pages 100031-100031
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1016/j.metop.2020.100031
• Subjects: Health Sciences, Pathology; Health Sciences, Medicine and Surgery; Health Sciences, Health Care Management
• Keywords: Diabetes; Dysglycemia; FPG; HbA1c; Oral glucose tolerance testing; Prediabetes

Abstract

Aims To assess whether meeting both fasting plasma glucose (FPG) and HbA1c criteria for prediabetes in people at high risk indicates with near certainty the presence of dysglycemia on repeat testing. Methods Observational study using data from Vitamin D and Type 2 Diabetes (D2d) study. HbA1c, FPG were measured at screening visit 1; FPG, HbA1c and 2 h plasma glucose (2hPG) measured at screening visit 2 (a median of 21 days later); participants classified as having normal glucose regulation (all 3 tests in normal range), prediabetes or diabetes (at least 1 of 3 tests in diabetes range). A predictive model was developed to estimate the probability of confirming dysglycemia and for detecting diabetes at screening visit 2 based on values of FPG and HbA1c at screening visit 1. Results Of 1271 participants who met both FPG and HbA1c criteria for prediabetes at screening visit 1, 98.6% exhibited dysglycemia (defined as prediabetes or diabetes) on repeat testing (84.5% were classified as having prediabetes, 14.1% were reclassified as having diabetes). Of those with diabetes, 62.6% were identified by 2hPG alone. Conclusions Combined measurement of FPG and HbA1c is a reliable and reproducible measure to identify presence of dysglycemia among people at high risk. A prediction model is provided to help clinicians decide whether an oral glucose tolerance test will provide value in detecting diabetes based on the 2hPG criterion.