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Cited by 370Diabetes Management and ResearchDiabetes, Cardiovascular Risks, and LipoproteinsDiabetes and associated disorders

Use of GHb (HbA1c) in screening for undiagnosed diabetes in the U.S. population.

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Rohlfing, C L, Little, R R, Wiedmeyer, H M, England, J D, Madsen, R, Harris, M I, Flegal, K M, Eberhardt, M S +1 more·2000·Diabetes Care
DOI 10.2337/diacare.23.2.187
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Abstract

OBJECTIVE: To evaluate the use of GHb as a screening test for undiagnosed diabetes (fasting plasma glucose > or =7.0 mmol/l) in a representative sample of the U.S. population. RESEARCH DESIGN AND METHODS: The Third National Health and Nutrition Examination Survey included national samples of non-Hispanic whites, non-Hispanic blacks, and Mexican Americans aged > or =20 years. Of these subjects, 7,832 participated in a morning examination session, of which 1,273 were excluded because of a previous diagnosis of diabetes, missing data, or fasting time of <8 h before examination. Venous blood was obtained to measure fasting plasma glucose and GHb in the remaining 6,559 subjects. Receiver operating characteristic curve analysis was used to examine the sensitivity and specificity of GHb for detecting diabetes at increasing GHb cutoff levels. RESULTS: GHb demonstrated high sensitivity (83.4%) and specificity (84.4%) for detecting undiagnosed diabetes at a GHb cutoff of 1 SD above the normal mean. Moderate sensitivity (63.2%) and very high specificity (97.4%) were evident at a GHb cutoff of 2 SD above the normal mean. Sensitivity at this level ranged from 58.6% in the non-Hispanic white population to 83.6% in the Mexican-American population; specificity ranged from 93.0% in the nonHispanic black population to 98.3% in the non-Hispanic white population. CONCLUSIONS: GHb is a highly specific and convenient alternative to fasting plasma glucose for diabetes screening. A GHb value of 2 SD above the normal mean could identify a high proportion of individuals with undiagnosed diabetes who are at risk for developing diabetes complications.

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  • Lowering the HbA1c cutoff value from 6.5% to 5.6% substantially increased sensitivity from 42.3% to 83.4% in the U.S. population.

    “For HbA1c, studies have shown that lowering the cutoff value from 6.5% to 5.6% substantially increased the sensitivity from 42.3% to 83.4% in U.S. population [16].”

    From A Novel Testing Model for Opportunistic Screening of Pre-Diabetes and Diabetes among U.S. Adults (2015) · cites this paper as [16]

    Table 2 (page not provided) reports sensitivity of 83.4% at an HbA1c cutoff of 5.6% in a representative U.S. population sample. At 6.5%, however, it reports 42.8%, not the claimed 42.3%. (LLM, conf=0.94)

    Experimental — accuracy not yet measured

  • The sensitivity of using HbA1c alone in detecting diabetes is unacceptably low, ranging from 63.2% at a cutoff of 6.1% to 28.3% at a cutoff of 7.0% in different populations.

    “However, the sensitivity of using HbA1c alone in detecting diabetes is unacceptably low, ranged from 63.2% at a cutoff value of 6.1% to 28.3% at a cutoff value of 7.0% in different populations [15,16].”

    From A Novel Testing Model for Opportunistic Screening of Pre-Diabetes and Diabetes among U.S. Adults (2015) · cites this paper as [16]

    Table 2 reports exactly 63.2% sensitivity at an HbA1c cutoff of 6.1% and 28.3% at 7.0%. These are different cutoffs in the same representative U.S. sample, not results from different populations. The Conclusions describe HbA1c as sensitive and specific for detecting undiagnosed diabetes, rather than calling its sensitivity unacceptably low. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Rohlfing et al. (NHANES III) found a sensitivity of 42.8% using HbA1c at a cutoff value of 6.5% for undiagnosed diabetes.

    “In the study conducted by Rohlfing et al. (NHANES III), the sensitivity was 42.8% using HbA1c at a cutoff value of 6.5% [16].”

    From A Novel Testing Model for Opportunistic Screening of Pre-Diabetes and Diabetes among U.S. Adults (2015) · cites this paper as [16]

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Authors
Rohlfing, C. L., Little, R. R., Wiedmeyer, H. M., England, J. D., Madsen, R., Harris, M. I., Flegal, K. M., Eberhardt, M. S., & Goldstein, D. E.
Affiliations
University of Missouri Health System (US)
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2000-02-01
Volume
23
Issue
2
Pages
187-191
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/diacare.23.2.187
OpenAlex
W2146852263
Cited by
370
References
0
Citations by year
2026: 2 · 2025: 2 · 2024: 7 · 2023: 7 · 2022: 5 · 2021: 8 · 2020: 15 · 2019: 13 · 2018: 15 · 2017: 7 · 2016: 13 · 2015: 15 · 2014: 12 · 2013: 19 · 2012: 24
FWCI
9.77
Type
journal article
Language
en
Open access
Locations
  • Diabetes Care (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
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
Keywords
HbA1c, diabetes screening, undiagnosed diabetes, fasting blood glucose, sensitivity and specificity, cut-off values, ethnic differences, Mexican Americans, African Americans, NHANES
MeSH terms
Adult, Aged, Black or African American, Blood Glucose, Diabetes Mellitus, Health Surveys, Glycated Hemoglobin, Hispanic or Latino, Humans, Mass Screening, Middle Aged, Nutrition Surveys, Regression Analysis, ROC Curve, Sensitivity and Specificity, United States, Biomarkers, Mexican Americans, Black People, White People

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