title: Identifying adults at high risk for diabetes and cardiovascular disease using hemoglobin A1c National Health and Nutrition Examination Survey 2005-2006.
abstract: BACKGROUND
  The American Diabetes Association (ADA) recently proposed the use of hemoglobin A1c as a practical and valid strategy to identify high-risk people for whom delivery of an intensive lifestyle intervention to prevent type 2 diabetes is likely to be cost effective.
  
  
  OBJECTIVE
  To estimate composite risks of developing diabetes and cardiovascular disease (CVD) for adults with different hemoglobin A1c test results and to compare those risks with those of adults who met the 2003 ADA definition for prediabetes.
  
  
  METHODS
  Cross-sectional data from the 2005-2006 National Health and Nutrition Examination Survey were analyzed in 2009. The method of Stern and colleagues was used to estimate the 7.5-year probability of type 2 diabetes, and the Framingham General CVD Risk Engine was used to estimate the 10-year probability of CVD for adults with different A1c results. Sample weights were used to account for sampling probability and to adjust for noncoverage and nonresponse.
  
  
  RESULTS
  Among adults meeting the 2003 ADA definition for prediabetes, the probabilities for incident type 2 diabetes (over 7.5 years) and CVD (over 10 years) were 33.5% and 10.7%, respectively. Use of A1c alone, in the range of 5.5% to <6.5%, would identify a population with comparable risks for diabetes (32.4% [SE=1.2%]) and CVD (11.4% [SE=0.6%]). A slightly higher cutoff (≥5.7%) would identify adults with risks of 41.3% (SE=1.5%) for diabetes and 13.3% (SE=0.8%) for CVD-risks that are comparable to people enrolled in the Diabetes Prevention Program.
  
  
  CONCLUSIONS
  A1c-based testing in clinical settings should be considered as a means to identify greater numbers of adults at high risk of developing type 2 diabetes and CVD.
authors.affiliation: Department of Medicine, Indiana University School of Medicine, Indianapolis, 46202, USA. rtackerm@iupui.edu
authors.forename: Ronald T
authors.initials: RT
authors.lastname: Ackermann
authors.forename: Yiling J
authors.initials: YJ
authors.lastname: Cheng
authors.forename: David F
authors.initials: DF
authors.lastname: Williamson
authors.forename: Edward W
authors.initials: EW
authors.lastname: Gregg
mesh_terms: D000293:Adolescent; D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D006442:Glycated Hemoglobin / Q000032:analysis*; D006306:Health Surveys; D006801:Humans; D008019:Life Style; D012307:Risk Factors; D012955:Societies, Medical; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D006442:Glycated Hemoglobin