title: The clinical significance of HbA1c as a predictive factor for abnormal postprandial glucose metabolism in NAFLD patients with an elevated liver chemistry.
abstract: OBJECTIVE
  NAFLD patients often show normal fasting glucose levels despite having abnormal postprandial glucose levels. This study is aimed at examining the possibility of utilizing HbA1c as a surrogate marker for abnormal glucose tolerance in NAFLD.
  
  
  METHODS
  This study was conducted on ninety-one NAFLD patients exhibiting elevated liver enzyme. Oral glucose tolerance tests (OGTT) (75g) were performed. Insulin concentrations were measured in a fasting state, and again at 120 minutes.
  
  
  RESULTS
  Sixteen subjects (44.7%) showed abnormal postprandial glucose levels among subjects with normal fasting glucose level (<100mg/dL). Among subjects whose fasting glucose levels were within the 100-125mg/dL range, 30 patients (68.2%) showed abnormal OGTT findings and 13 patients (29.5%) were diagnosed as diabetics. In univariate analysis, the predictive factors for abnormal glucose tolerance were found to be HbA1c, age, fasting glucose and 120-minute insulin. However, in multivariate analysis, only HbA1c was found to be a significant predictive factor ((β)=0.43, p=0.017). The mean values for HbA1c were higher in the diabetes (6.2%) and glucose intolerance groups (5.8%) than in the normal group (5.5%). Using HbA1c 5.8% as the cut-off level in AUROC, sensitivity and specificity for predicting abnormal OGTT were 71.0% and 89.9%. Of NAFLD patients who showed HbA1c concentrations of 5.8% or higher, 90.9% showed abnormal OGTT.
  
  
  CONCLUSIONS
  In NAFLD patients, an HbA1c concentration of 5.8% or higher can be used as an index for predicting abnormal postprandial glucose tolerance.
authors.affiliation: Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea.
authors.forename: Dae Won
authors.initials: DW
authors.lastname: Jun
authors.forename: Hyo Jeong
authors.initials: HJ
authors.lastname: Kim
authors.forename: June Ho
authors.initials: JH
authors.lastname: Bae
authors.forename: Oh Young
authors.initials: OY
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D005234:Fatty Liver / Q000378:metabolism*; D005947:Glucose / Q000378:metabolism*; D018149:Glucose Intolerance / Q000175:diagnosis*; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D008875:Middle Aged; D019518:Postprandial Period / Q000502:physiology*
chemical_list: D005947:Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human