hba 1c 5.7-6.4% and impaired fasting plasma glucose for diagnosis of prediabetes and risk of...
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HbA1c5.7-6.4% and impaired fasting plasma glucose for diagnosis of prediabetes and risk of progression to diabetes in Japan(TOPICS3)
Yoriko Heianza, Shigeko Hara, Yasuji Arase, Kazumi Saito, Kazuya Fujiwara, Hiroshi Tsuji, Satoru Kodama, Shiun Dong Hsieh, Yasumichi Mori, Hitoshi Shimano, Nobuhiro Yamada, Kinori Kosaka, Hirohito Sone.Lancet 2011; 378: 147-55
Jon Wilson2012 PharmD CandidateMercer University COPHS
Prediabetes ADA guidelines criterion...
1)Impaired Fasting Glucose of 5.6 - 6.9mmol/L
Or
2)HbA1c of 5.7-6.4%
Diabetes
ADA guidelines criterion…
1)Fasting plasma glucose of 7.0mmol/L or higher
Or
2)HbA1c of 6.5% or higher
Objective
Compare the prevalence of prediabetes when diagnosed by HbA1c5.7-6.4% or by impaired fasting glucose and assess differences in progression rate to diabetes between the two criteria.
Study
Longitudinal cohort study
Between 1997 and 2003
Toranomon Hospital in Tokyo, Japan
Look at annual examinations for government employees
Rate of progression to diabetes was assessed annually
Began with 32,057 patients, aged 24-87 years old
Inclusion/Exclusion
Inclusion Patients who had annual examinations
regularly for 4 or 5 years Exclusion
Patients who were diagnosed with diabetes at baseline
6241 patients were eligible for the 6241 patients were eligible for the studystudy
Subgroups
Patients divided into 4 subgroups on basis of baseline diagnosis1)Impaired fasting glucose alone2)HbA1c alone
3)Both IFG and HbA1c
4)Normoglycaemia
Prevalence of prediabetes
Results
338 incident cases of diabetes during mean 4.7 year follow up
1)IFG alone- 32%(n=108)
2)HbA1c alone- 9%(n=30)
3)Both- 46%(n=154)
Results
Patients progressing to diabetes after 5 years
1)IFG- 9%(108/1270 cases)
2)HbA1c alone-7%(30/412 cases)
3)Both-38%(154/410 cases)
Results
Statistics
Hazard Ratios compared with normoglycaemic individuals
1)IFG alone: 6.16(95%CI 4.33-8.77)
2)HbA1c alone: 6.00(95%CI 3.76-9.56)
3)Both: 31.9(95%CI 22.6-45.0)
Conclusion
Diagnosis of prediabetes by both HbA1c and impaired fasting glucose ADA criteria resulted in increased risk of progression to diabetes.
Comment
By determining the likelihood of a patient with prediabetes progressing to diabetes, one can provide early intervention such as lifestyle modifications for control and possibly prevention.