title: Fasting plasma glucose and glycated haemoglobin in the screening of diabetes and impaired glucose tolerance.
abstract: The use of fasting plasma glucose (FPG) only has been proposed for the screening and diagnosis of diabetes, but its sensitivity has been reported to be unsatisfactory. The use of HbA1C, alone or combined with FPG, has been suggested for the screening of diabetes and impaired glucose tolerance (IGT). In a sample of 1215 adult subjects without previously known diabetes, we assessed the sensitivity and specificity of FPG and HbA1C in diagnosing diabetes and IGT, determined by oral glucose tolerance test (OGTT). All lean diabetic patients, and 85% of overweight and obese diabetic individuals, had FPG > or =7 mmol/l. FPG >6.1 mmol/l had a sensitivity of 98.8% and a specificity of 32.9%; HbA1C had a lower specificity and sensitivity for the screening of diabetes. A screening strategy for diabetes based on FPG, with OGTT in all overweight subjects with FPG >6.1 mmol/l, is suggested. Neither FPG nor HbA1C is effective in the screening of IGT; although combined FPG and HbA1C could be useful for case finding, screening for IGT with OGTT is advisable in all subjects at high risk.
authors.affiliation: Section of Metabolic Diseases and Diabetology, Endocrine Unit, Department of Clinical Pathophysiology, University of Florence Medical School, Viale Pieraccini 6, I-50134 Florence, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Mannucci
authors.forename: A
authors.initials: A
authors.lastname: Ognibene
authors.forename: I
authors.initials: I
authors.lastname: Sposato
authors.forename: M
authors.initials: M
authors.lastname: Brogi
authors.forename: G
authors.initials: G
authors.lastname: Gallori
authors.forename: G
authors.initials: G
authors.lastname: Bardini
authors.forename: F
authors.initials: F
authors.lastname: Cremasco
authors.forename: G
authors.initials: G
authors.lastname: Messeri
authors.forename: C M
authors.initials: CM
authors.lastname: Rotella
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis / Q000378:metabolism*; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D005215:Fasting; D005260:Female; D005602:France / Q000453:epidemiology; D018149:Glucose Intolerance / Q000097:blood / Q000175:diagnosis*; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D009765:Obesity; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012727:Sex Characteristics
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin