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Cited by 213Diabetes Management and ResearchDiabetes, Cardiovascular Risks, and LipoproteinsHealth Promotion and Cardiovascular Prevention

Utility of hemoglobin A1c in predicting diabetes risk

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Edelman, David, Olsen, Maren K., Dudley, Tara K., Harris, Amy C., Oddone, Eugene Z.·2004·Journal of General Internal Medicine
DOI 10.1111/j.1525-1497.2004.40178.xPMC PMC1492588
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Abstract

Background There is controversy surrounding the issue of whether, and how, to screen adults for type 2 diabetes. Our objective was to measure the incidence of new diabetes among outpatients enrolled in a health care system, and to determine whether hemoglobin A1c (HbA1c) values would allow risk stratification for patients' likelihood of developing diabetes over 3 years.Methods We conducted a prospective cohort study with 3-year follow-up at a single large, tertiary care, Department of Veterans Affairs Medical Center (VAMC). A convenience sample of 1,253 outpatients without diabetes, age 45 to 64, with a scheduled visit at the VAMC, were screened for diabetes using an initial HbA1c measurement. All subjects with HbA1c > or = 6.0% (normal, 4.0% to 6.0%) were invited for follow-up fasting plasma glucose (FPG). We then surveyed patients annually for 3 years to ascertain interval diagnosis of diabetes by a physician. The baseline screening process was repeated 3 years after initial screening. After the baseline screening, new cases of diabetes were defined as either the self-report of a physician's diagnosis of diabetes, or by HbA1c > or = 7.0% or FPG > or = 7.0 mmol/L at 3-year follow-up. The incidence of diabetes was calculated as the number of new cases per person-year of follow-up.Results One thousand two hundred fifty-three patients were screened initially, and 56 (4.5%) were found to have prevalent unrecognized diabetes at baseline. The 1,197 patients without diabetes at baseline accrued 3,257 person-years of follow-up. There were 73 new cases of diabetes over 3 years of follow-up, with an annual incidence of 2.2% (95% confidence interval [CI], 1.7% to 2.7%). In a multivariable logistic regression model, baseline HbA1c and baseline body mass index (BMI) were the only significant predictors of new onset diabetes, with HbA1c having a greater effect than BMI. The annual incidence of diabetes for patients with baseline HbA1c < or = 5.5 was 0.8% (CI, 0.4% to 1.2%); for HbA1c 5.6 to 6.0, 2.5% (CI, 1.6% to 3.5%); and for HbA1c 6.1 to 6.9, 7.8% (CI, 5.2% to 10.4%). Obese patients with HbA1c 5.6 to 6.0 had an annual incidence of diabetes of 4.1% (CI, 2.2% to 6.0%).Conclusions HbA1c testing helps predict the likelihood that patients will develop diabetes in the future. Patients with normal HbA1c have a low incidence of diabetes and may not require rescreening in 3 years. However, patients with elevated HbA1c who do not have diabetes may need more careful follow-up and possibly aggressive treatment to reduce the risk of diabetes. Patients with high-normal HbA1c may require follow-up sooner than 3 years, especially if they are significantly overweight or obese. This predictive value suggests that HbA1c may be a useful test for periodic diabetes screening.

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  • Incidence of diabetes in people with A1C levels in the 6.0 to <6.5% range is more than 10 times that of people with lower levels.

    “Indeed, incidence of diabetes in people with A1C levels in this range is more than 10 times that of people with lower levels (4–7).”

    From Diagnosis and classification of diabetes mellitus (2013) · cites this paper as [4]

  • People within the A1C range of 5.5-6.0% have a 5-year cumulative incidence of diabetes that ranges from 12 to 25%.

    “Prospective studies indicate that people within the A1C range of 5.5–6.0% have a 5-year cumulative incidence of diabetes that ranges from 12 to 25% (4–7), which is appreciably (three- to eightfold) higher than incidence in the U.S. population as a whole (8).”

    From Diagnosis and classification of diabetes mellitus (2013) · cites this paper as [4]

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  1. [2]2. Harris MI. Impaired glucose tolerance in the US population. Diabetes Care. 1989;12:464 -74.

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Authors
Edelman, D., Olsen, M. K., Dudley, T. K., Harris, A. C., & Oddone, E. Z.
Affiliations
  • Duke University (US)
  • Durham VA Medical Center (US)
Corresponding author
Edelman, David
ORCID
Venue
Journal of General Internal Medicine
Publisher
Springer Science and Business Media LLC
Published
2004-12
Volume
19
Issue
12
Pages
1175-1180
ISSN
  • 0884-8734 (ISSN-L)
  • 1525-1497
DOI
10.1111/j.1525-1497.2004.40178.x
PMC
PMC1492588
OpenAlex
W2044864388
Cited by
213
References
38
Citations by year
2026: 2 · 2025: 6 · 2024: 4 · 2023: 11 · 2022: 4 · 2021: 7 · 2020: 11 · 2019: 8 · 2018: 7 · 2017: 4 · 2016: 17 · 2015: 11 · 2014: 14 · 2013: 12 · 2012: 10
FWCI
4.07
Type
journal article
Language
en
Open access
Locations
  • Journal of General Internal Medicine (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
Keywords
HbA1c, type 2 diabetes, diabetes screening, diabetes risk prediction, risk stratification, diabetes incidence, fasting blood glucose, body mass index, veterans, outpatients, undiagnosed diabetes, glycemic control, veterans health system, prediabetes, Diabetes Prevention Program, prediabetes screening
MeSH terms
Blood Glucose, Diabetes Mellitus, Type 2, Follow-Up Studies, Glycated Hemoglobin, Humans, Middle Aged, Obesity, Prospective Studies, Regression Analysis, Body Mass Index

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