Performance Characteristics of the New Definition of Diabetes
Open accessAbstract
OBJECTIVE: A1C ≥6.5% has been recently proposed as the defining criterion for diabetes. However, performance characteristics of this definition have not been described. RESEARCH DESIGN AND METHODS: In the Insulin Resistance Atherosclerosis Study, we compared new to previous definitions of diabetes: 1999 World Health Organization (DM1999WHO) and 2003 American Diabetes Association based on fasting glucose alone (DMFPG126). RESULTS: Participants with A1C ≥6.5%, DM1999WHO, and DMFPG126 were 44 (5.2%), 132 (15.4%), and 61 (7.1%), respectively. In individuals with DM1999WHO, mean, median, and interquartile range of A1C were 6.3, 5.9, and 5.5–6.6%, respectively; in individuals with DMFPG126, mean, median, and interquartile range of A1C were 7.0, 6.6, and 6.0–7.1%. CONCLUSIONS: A1C ≥6.5% identifies fewer individuals than DM1999WHO or DMFPG126. Studies are needed to determine that A1C ≥6.5% compromises neither blood pressure and lipid management in early diabetes nor the implementation of lifestyle interventions for diabetes prevention.
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The IEC A1C criteria have recently been compared with testing with fasting glucose or OGTTs in various populations to diagnose diabetes and high-risk/pre-diabetes.
“The IEC A1C criteria have recently been compared with testing with fasting glucose or oral glucose tolerance tests (OGTTs) in various populations to diagnose diabetes (7–13) and high-risk/pre-diabetes (10,11,13), but the ADA A1C criteria have not been studied.”
From Screening for Diabetes and Pre-Diabetes With Proposed A1C-Based Diagnostic Criteria (2010) · cites this paper as [12]
The Methods and Results compare the IEC A1C diabetes threshold with fasting-glucose and WHO criteria incorporating two-hour glucose testing in IRAS participants. The paper also examines the A1C 6.0–6.4% high-risk category, but does not directly compare A1C with glucose-based criteria for diagnosing pre-diabetes. Its findings come from one study population; the sentence cites several papers for the broader claim about various populations. (LLM, conf=0.83)
Experimental — accuracy not yet measuredProblems with the IEC criteria have been reported with diverse populations.
“Further studies would be required before our findings with the ADA criteria could be generalized to other racial/ethnic groups, but problems with the IEC criteria have been reported with diverse populations (8,9,12).”
From Screening for Diabetes and Pre-Diabetes With Proposed A1C-Based Diagnostic Criteria (2010) · cites this paper as [12]
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- Authors
- Lorenzo, C., & Haffner, S. M.
- Affiliations
- The University of Texas at San Antonio Health Science Center (US)
- Corresponding author
- Lorenzo, Carlos
- ORCID
- Lorenzo, Carlos
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2009-10-30
- Volume
- 33
- Issue
- 2
- Pages
- 335-337
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC2809276
- OpenAlex
- W2156892298
- Cited by
- 53
- References
- 16
- Citations by year
- 2023: 1 · 2022: 1 · 2021: 3 · 2020: 1 · 2019: 2 · 2017: 3 · 2016: 2 · 2015: 3 · 2014: 6 · 2013: 6 · 2012: 8
- FWCI
- 6.07
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Diabetes Care (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Funders
- Deutsches Krebsforschungszentrum
- National Institutes of Health (5u01hl047890-09, 5u01hl047887-09, 5u01hl047889-09)
- National Heart, Lung, and Blood Institute (U01HL047902, HL-47889, HL‐47890, HL47887, U01HL047892, HL 47892)
- National Center for Research Resources (M01RR01346, M01RR001346, M01-RR431)
- 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
- diabetes diagnosis, HbA1c, diagnostic criteria, fasting blood glucose, Insulin Resistance Atherosclerosis Study, sensitivity and specificity, diabetes prevention
- MeSH terms
- Blood Glucose, Diabetes Mellitus, Diabetes Mellitus, Type 2, Fasting, Glycated Hemoglobin, Humans, Insulin Resistance, ROC Curve, United States, World Health Organization, Incidence, Atherosclerosis
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