Comparison of the Current Diagnostic Criterion of HbA1c with Fasting and 2-Hour Plasma Glucose Concentration
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To determine the effectiveness of hemoglobin A1c (HbA1c) ≥ 6.5% in diagnosing diabetes compared to fasting plasma glucose (FPG) ≥ 126 mg/dL and 2-hour plasma glucose (2hPG) ≥ 200 mg/dL in a previously undiagnosed diabetic cohort, we included 5,764 adult subjects without established diabetes for whom HbA1c, FPG, 2hPG, and BMI measurements were collected. Compared to the FPG criterion, the sensitivity of HbA1c ≥ 6.5% was only 43.3% (106 subjects). Compared to the 2hPG criterion, the sensitivity of HbA1c ≥ 6.5% was only 28.1% (110 subjects). Patients who were diabetic using 2hPG criterion but had HbA1c < 6.5% were more likely to be older (64±15versus60±15years old,P=0.01, mean ± STD), female (53.2% versus 38.2%,P=0.008), leaner (29.7±6.1versus33.0±6.6 kg/m 2,P=0.000005), and less likely to be current smokers (18.1% versus 29.1%,P=0.02) as compared to those with HbA1c ≥ 6.5%. The diagnostic agreement in the clinical setting revealed the current HbA1c ≥ 6.5% is less likely to detect diabetes than those defined by FPG and 2hPG. HbA1c ≥ 6.5% detects less than 50% of diabetic patients defined by FPG and less than 30% of diabetic patients defined by 2hPG. When the diagnosis of diabetes is in doubt by HbA1c, FPG and/or 2hPG should be obtained.
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Because the concordance among diagnostic tests is imperfect, diagnosis of DM requires two abnormal test results unless hyperglycemic symptoms accompany a glucose level of at least 200 mg/dL.
“The concordance between FPG, 2-hour PG, and A1C is not perfect; thus, the diagnosis of DM requires 2 different (fasting glucose and A1C) abnormal test results, either from the same sample or 2 abnormal results on samples drawn on different days.”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [5]
The Discussion reports imperfect agreement among HbA1c, fasting plasma glucose, and 2-hour plasma glucose, and says diabetes diagnosis requires repeated measurement rather than a single test. It does not specify that the two abnormal results must be from different tests, describe the same-sample or different-day options, or state an exception for hyperglycemic symptoms with glucose of at least 200 mg/dL. (LLM, conf=0.88)
Experimental — accuracy not yet measuredA1C has lower sensitivity than fasting plasma glucose or 2-hour oral glucose tolerance test for diagnosing diabetes.
“analyses of the fidelity of DM diagnosis using A1C have reported a lower sensitivity than FPG or 2-hour OGTT.4,5,7-10”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [5]
The concordance among fasting plasma glucose, 2-hour plasma glucose, and A1C is imperfect.
“The concordance between FPG, 2-hour PG, and A1C is not perfect”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [5]
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- Authors
- Karnchanasorn, R., Huang, J., Ou, H.-Y., Feng, W., Chuang, L.-M., Chiu, K. C., & Samoa, R.
- Affiliations
- University of Kansas Medical Center (US)
- City Of Hope National Medical Center (US)
- National Cheng Kung University Hospital (TW)
- National Taiwan University (TW)
- Corresponding author
- Chiu, Ken C.
- Venue
- Journal of Diabetes Research
- Publisher
- Wiley
- Published
- 2016
- Volume
- 2016
- Pages
- 1-11
- ISSN
- 2314-6745 (ISSN-L)
- 2314-6753
- PMC
- PMC4997021
- OpenAlex
- W2516327906
- Cited by
- 59
- References
- 41
- Citations by year
- 2026: 5 · 2025: 6 · 2024: 3 · 2023: 10 · 2022: 9 · 2021: 8 · 2020: 8 · 2019: 2 · 2018: 7 · 2017: 1
- FWCI
- 3.35
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Journal of Diabetes Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Jie Chan Chen foundation
- 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 › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- HbA1c, fasting blood glucose, 2-hour oral glucose tolerance test, diabetes diagnosis, diagnostic sensitivity, diagnostic criteria comparison, undiagnosed diabetes, body mass index, smoking status
- MeSH terms
- Adult, Aged, Blood Glucose, Diabetes Mellitus, Type 2, Fasting, Female, Glucose Tolerance Test, Glycated Hemoglobin, Humans, Male, Middle Aged, Nutrition Surveys, Cohort Studies
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