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Cited by 118Diabetes, Cardiovascular Risks, and LipoproteinsDiabetes Management and ResearchDiabetes Treatment and Management

A1C Cut Points to Define Various Glucose Intolerance Groups in Asian Indians

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Mohan, Viswanathan, Vijayachandrika, Venkataraman, Gokulakrishnan, Kuppan, Anjana, Ranjit Mohan, Ganesan, Anbazhagan, Weber, Mary Beth, Narayan, K.M. Venkat·2010·Diabetes Care
DOI 10.2337/dc09-1694PMC PMC2827500
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Abstract

OBJECTIVE: To determine A1C cut points for glucose intolerance in Asian Indians. RESEARCH DESIGN AND METHODS: A total of 2,188 participants without known diabetes were randomly selected from the Chennai Urban Rural Epidemiology Study. All had fasting plasma glucose (FPG) and 2-h postload plasma glucose measurements after a 75-g load and were classified as having impaired fasting glucose (IFG) (American Diabetes Association [ADA] criteria, FPG ≥5.5 and <7 mmol/l, and World Health Organization [WHO] criteria, FPG ≥6.1 and <7 mmol/l), impaired glucose tolerance (IGT) (2-h postload plasma glucose ≥7.8 and <11.1 mmol/l), or diabetes (FPG ≥7 mmol/l and/or 2-h postload plasma glucose ≥11.1 mmol/l). A1C was measured using the Bio-Rad Variant machine. Based on receiver operating characteristic curves, optimum sensitivity and specificity were derived for defining A1C cut points for diabetes, IGT, and IFG. RESULTS: Mean ± SD values of A1C among subjects with normal glucose tolerance, IGT, and diabetes were 5.5 ± 0.4, 5.9 ± 0.6, and 8.3 ± 2.0%, respectively (Ptrend < 0.001) with considerable overlap. To identify diabetes based on 2-h postload plasma glucose, the A1C cut point of 6.1% had an area under the curve (AUC) of 0.941 with 88.0% sensitivity and 87.9% specificity. When diabetes was defined as FPG ≥7.0 mmol/l, the A1C cut point was 6.4% (AUC = 0.966, sensitivity 93.3%, and specificity 92.3%). For IGT, AUC = 0.708; for IFG, AUC = 0.632 (WHO criteria) and 0.708 (ADA criteria), and the A1C cut point was 5.6%. CONCLUSIONS: In Asian Indians, A1C cut points of 6.1 and 6.4% defined diabetes by 2-h postload plasma glucose or FPG criteria, respectively. A value of 5.6% optimally identified IGT or IFG but was <70% accurate.

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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 [11]

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  1. [21]Saudek CD Derr RL Kalyani RR: Assessing glycemia in diabetes using self-monitoring blood glucose and hemoglobin A1c. JAMA 2006; 295: 1688– 1697 16609091

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Authors
Mohan, V., Vijayachandrika, V., Gokulakrishnan, K., Anjana, R. M., Ganesan, A., Weber, M. B., & Narayan, K. M. V.
Affiliations
  • Madras Diabetes Research Foundation (IN)
  • Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, World Health Organization Collaborating Centre for Non-Communicable Diseases Prevention and Control, and International Diabetes Federation Centre for Education, Chennai, India;
  • Emory University (US)
Corresponding author
Mohan, Viswanathan
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2009-11-10
Volume
33
Issue
3
Pages
515-519
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/dc09-1694
PMC
PMC2827500
OpenAlex
W2131658928
Cited by
118
References
31
Citations by year
2026: 3 · 2025: 2 · 2024: 2 · 2023: 1 · 2022: 4 · 2021: 4 · 2020: 5 · 2019: 2 · 2018: 4 · 2017: 7 · 2016: 8 · 2015: 7 · 2014: 13 · 2013: 12 · 2012: 19
FWCI
10.68
Type
journal article
Language
en
Open access
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)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Keywords
HbA1c, impaired glucose tolerance, impaired fasting glucose, diabetes diagnosis, Asian Indians, fasting blood glucose, diagnostic accuracy, WHO criteria, ADA criteria, prediabetes, glycemic targets
MeSH terms
Adult, Algorithms, Blood Glucose, Cross-Sectional Studies, Diagnostic Techniques, Endocrine, Glycated Hemoglobin, Humans, India, Middle Aged, Population, Reference Values, Sensitivity and Specificity, Prevalence, Glucose Intolerance, Area Under Curve, Asian People

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