Discrepancies between glycosylated hemoglobin and fasting plasma glucose for diagnosing impaired fasting glucose and diabetes mellitus in korean youth and young adults

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Abstract

Background: Glycosylated hemoglobin (HbA1c) has been recommended as a diagnostic test for prediabetes and diabetes. Here, we evaluated the level of agreement between diagnoses based on fasting plasma glucose (FPG) versus HbA1c levels and determined optimal HbA1c cutoff values for these diseases in youth and young adults. Methods: The study included 7,332 subjects (n=4,129, aged 10 to 19 years in youth group; and n=3,203 aged 20 to 29 years in young adult group) from the 2011 to 2016 Korea National Health and Nutrition Examination Survey. Prediabetes and diabetes were defined as 100 to 125 mg/dL (impaired fasting glucose [IFG]) and ≥126 mg/dL for FPG (diabetes mellitus [DM] by FPG [DMFPG]), and 5.7% to 6.4% and ≥6.5% for HbA1c, respectively. Results: In the youth group, 32.5% with IFG had an HbA1c level of 5.7% to 6.4%, and 72.2% with DMFPG had an HbA1c ≥6.5%. In the young adult group, 27.5% with IFG had an HbA1c level of 5.7% to 6.4%, and 66.6% with DMFPG had an HbA1c ≥6.5%. Kappa coefficients for agreement between the FPG and HbA1c results were 0.12 for the youth group and 0.19 for the young adult group. In receiver operating characteristic curve analysis, the optimal HbA1c cutoff for IFG and DMFPG were 5.6% and 5.9% in youths and 5.5% and 5.8% in young adults, respectively. Conclusion: Usefulness of HbA1c for diagnosis of IFG and DMFPG in Koreans aged <30 years remains to be determined due to discrepancies between the results of glucose- and HbA1c-based tests. Additional testing might be warranted at lower HbA1c levels to detect IFG and DMFPG in this age group.

Original languageEnglish
Pages (from-to)174-182
Number of pages9
JournalDiabetes and Metabolism Journal
Volume43
Issue number2
DOIs
StatePublished - 1 Apr 2019

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Glycosylated Hemoglobin A
Young Adult
Fasting
Diabetes Mellitus
Glucose
Prediabetic State
Nutrition Surveys
Korea
Routine Diagnostic Tests
ROC Curve
Age Groups

Keywords

  • Adolescent
  • Blood glucose
  • Diabetes mellitus
  • Diagnosis
  • Glycated hemoglobin A
  • Prediabetic state
  • Young adult

Cite this

@article{2229a4a5f1f9472e83f9159aaa1aa223,
title = "Discrepancies between glycosylated hemoglobin and fasting plasma glucose for diagnosing impaired fasting glucose and diabetes mellitus in korean youth and young adults",
abstract = "Background: Glycosylated hemoglobin (HbA1c) has been recommended as a diagnostic test for prediabetes and diabetes. Here, we evaluated the level of agreement between diagnoses based on fasting plasma glucose (FPG) versus HbA1c levels and determined optimal HbA1c cutoff values for these diseases in youth and young adults. Methods: The study included 7,332 subjects (n=4,129, aged 10 to 19 years in youth group; and n=3,203 aged 20 to 29 years in young adult group) from the 2011 to 2016 Korea National Health and Nutrition Examination Survey. Prediabetes and diabetes were defined as 100 to 125 mg/dL (impaired fasting glucose [IFG]) and ≥126 mg/dL for FPG (diabetes mellitus [DM] by FPG [DMFPG]), and 5.7{\%} to 6.4{\%} and ≥6.5{\%} for HbA1c, respectively. Results: In the youth group, 32.5{\%} with IFG had an HbA1c level of 5.7{\%} to 6.4{\%}, and 72.2{\%} with DMFPG had an HbA1c ≥6.5{\%}. In the young adult group, 27.5{\%} with IFG had an HbA1c level of 5.7{\%} to 6.4{\%}, and 66.6{\%} with DMFPG had an HbA1c ≥6.5{\%}. Kappa coefficients for agreement between the FPG and HbA1c results were 0.12 for the youth group and 0.19 for the young adult group. In receiver operating characteristic curve analysis, the optimal HbA1c cutoff for IFG and DMFPG were 5.6{\%} and 5.9{\%} in youths and 5.5{\%} and 5.8{\%} in young adults, respectively. Conclusion: Usefulness of HbA1c for diagnosis of IFG and DMFPG in Koreans aged <30 years remains to be determined due to discrepancies between the results of glucose- and HbA1c-based tests. Additional testing might be warranted at lower HbA1c levels to detect IFG and DMFPG in this age group.",
keywords = "Adolescent, Blood glucose, Diabetes mellitus, Diagnosis, Glycated hemoglobin A, Prediabetic state, Young adult",
author = "Jieun Lee and Lee, {Young Ah} and Jae-Hyun Kim and Lee, {Seong Yong} and Shin, {Choong Ho} and Seiwon Yang",
year = "2019",
month = "4",
day = "1",
doi = "10.4093/dmj.2018.0046",
language = "English",
volume = "43",
pages = "174--182",
journal = "Diabetes and Metabolism Journal",
issn = "2233-6079",
publisher = "Korean Diabetes Association",
number = "2",

}

TY - JOUR

T1 - Discrepancies between glycosylated hemoglobin and fasting plasma glucose for diagnosing impaired fasting glucose and diabetes mellitus in korean youth and young adults

AU - Lee, Jieun

AU - Lee, Young Ah

AU - Kim, Jae-Hyun

AU - Lee, Seong Yong

AU - Shin, Choong Ho

AU - Yang, Seiwon

PY - 2019/4/1

Y1 - 2019/4/1

N2 - Background: Glycosylated hemoglobin (HbA1c) has been recommended as a diagnostic test for prediabetes and diabetes. Here, we evaluated the level of agreement between diagnoses based on fasting plasma glucose (FPG) versus HbA1c levels and determined optimal HbA1c cutoff values for these diseases in youth and young adults. Methods: The study included 7,332 subjects (n=4,129, aged 10 to 19 years in youth group; and n=3,203 aged 20 to 29 years in young adult group) from the 2011 to 2016 Korea National Health and Nutrition Examination Survey. Prediabetes and diabetes were defined as 100 to 125 mg/dL (impaired fasting glucose [IFG]) and ≥126 mg/dL for FPG (diabetes mellitus [DM] by FPG [DMFPG]), and 5.7% to 6.4% and ≥6.5% for HbA1c, respectively. Results: In the youth group, 32.5% with IFG had an HbA1c level of 5.7% to 6.4%, and 72.2% with DMFPG had an HbA1c ≥6.5%. In the young adult group, 27.5% with IFG had an HbA1c level of 5.7% to 6.4%, and 66.6% with DMFPG had an HbA1c ≥6.5%. Kappa coefficients for agreement between the FPG and HbA1c results were 0.12 for the youth group and 0.19 for the young adult group. In receiver operating characteristic curve analysis, the optimal HbA1c cutoff for IFG and DMFPG were 5.6% and 5.9% in youths and 5.5% and 5.8% in young adults, respectively. Conclusion: Usefulness of HbA1c for diagnosis of IFG and DMFPG in Koreans aged <30 years remains to be determined due to discrepancies between the results of glucose- and HbA1c-based tests. Additional testing might be warranted at lower HbA1c levels to detect IFG and DMFPG in this age group.

AB - Background: Glycosylated hemoglobin (HbA1c) has been recommended as a diagnostic test for prediabetes and diabetes. Here, we evaluated the level of agreement between diagnoses based on fasting plasma glucose (FPG) versus HbA1c levels and determined optimal HbA1c cutoff values for these diseases in youth and young adults. Methods: The study included 7,332 subjects (n=4,129, aged 10 to 19 years in youth group; and n=3,203 aged 20 to 29 years in young adult group) from the 2011 to 2016 Korea National Health and Nutrition Examination Survey. Prediabetes and diabetes were defined as 100 to 125 mg/dL (impaired fasting glucose [IFG]) and ≥126 mg/dL for FPG (diabetes mellitus [DM] by FPG [DMFPG]), and 5.7% to 6.4% and ≥6.5% for HbA1c, respectively. Results: In the youth group, 32.5% with IFG had an HbA1c level of 5.7% to 6.4%, and 72.2% with DMFPG had an HbA1c ≥6.5%. In the young adult group, 27.5% with IFG had an HbA1c level of 5.7% to 6.4%, and 66.6% with DMFPG had an HbA1c ≥6.5%. Kappa coefficients for agreement between the FPG and HbA1c results were 0.12 for the youth group and 0.19 for the young adult group. In receiver operating characteristic curve analysis, the optimal HbA1c cutoff for IFG and DMFPG were 5.6% and 5.9% in youths and 5.5% and 5.8% in young adults, respectively. Conclusion: Usefulness of HbA1c for diagnosis of IFG and DMFPG in Koreans aged <30 years remains to be determined due to discrepancies between the results of glucose- and HbA1c-based tests. Additional testing might be warranted at lower HbA1c levels to detect IFG and DMFPG in this age group.

KW - Adolescent

KW - Blood glucose

KW - Diabetes mellitus

KW - Diagnosis

KW - Glycated hemoglobin A

KW - Prediabetic state

KW - Young adult

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U2 - 10.4093/dmj.2018.0046

DO - 10.4093/dmj.2018.0046

M3 - Article

VL - 43

SP - 174

EP - 182

JO - Diabetes and Metabolism Journal

JF - Diabetes and Metabolism Journal

SN - 2233-6079

IS - 2

ER -