A1C and Diabetes Diagnosis: The Rancho Bernardo Study
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OBJECTIVE: To examine the sensitivity and specificity of A1C as a diagnostic test for type 2 diabetes in older adults. RESEARCH DESIGN AND METHODS: Cross-sectional study of community-dwelling adults without known diabetes who had an oral glucose tolerance test and A1C measured on the same day. RESULTS: Mean age of the 2,107 participants was 69.4 ± 11.1 years; 43% were men. Based on the American Diabetes Association (ADA) criteria, 198 had previously undiagnosed type 2 diabetes. The sensitivity/specificity of A1C cut point of 6.5% was 44/79%. Results were similar in age- and sex-stratified analyses. Given the A1C cut point of 6.5%, 85% of participants were classified as nondiabetic by ADA criteria. CONCLUSIONS: The limited sensitivity of the A1C test may result in delayed diagnosis of type 2 diabetes, while the strict use of ADA criteria may fail to identify a high proportion of individuals with diabetes by A1C ≥6.5% or retinopathy.
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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 [8]
The Results and Conclusions compare the A1C ≥6.5% diabetes threshold with fasting-glucose and OGTT criteria in older adults. The paper discusses missed pre-diabetes, but our copy does not show a comparison of IEC A1C high-risk/pre-diabetes criteria with those glucose tests. (LLM, conf=0.82)
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 [8]
The Results report low agreement between the IEC-recommended A1C cutoff of 6.5% and diabetes diagnosis by ADA criteria in this cohort of older adults. The Conclusions also compare the finding with NHANES data, but this paper does not establish that the problem occurs across diverse racial or ethnic populations. (LLM, conf=0.83)
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- Authors
- Kramer, C. K., Araneta, M. R. G., & Barrett-Connor, E.
- Affiliations
- Universidade Federal do Rio Grande do Sul (BR)
- University of California San Diego (US)
- Corresponding author
- Barrett-Connor, Elizabeth
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2009-10-16
- Volume
- 33
- Issue
- 1
- Pages
- 101-103
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC2797952
- OpenAlex
- W2108321760
- Cited by
- 157
- References
- 16
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 3 · 2023: 3 · 2022: 3 · 2021: 4 · 2020: 6 · 2019: 3 · 2018: 7 · 2017: 9 · 2016: 11 · 2015: 9 · 2014: 17 · 2013: 13 · 2012: 15
- FWCI
- 16.03
- 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
- Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
- National Institute on Aging (R37AG007181, AG07181, R01AG007181, AG028507, R01AG028507)
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK031801)
- 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, type 2 diabetes diagnosis, sensitivity and specificity, older adults, undiagnosed diabetes, ADA diagnostic criteria, oral glucose tolerance test, delayed diagnosis, retinopathy
- MeSH terms
- Aged, Aged, 80 and over, Cross-Sectional Studies, Diabetes Mellitus, Type 2, Female, Glucose Tolerance Test, Glycated Hemoglobin, Humans, Male, Middle Aged
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