title: Use of high-normal levels of haemoglobin A(1C) and fasting plasma glucose for diabetes screening and for prediction: a meta-analysis.
abstract: BACKGROUND
  Using high-normal levels of haemoglobin A1C (Abnormal-A1C ) or fasting plasma glucose (FPG) (Abnormal-FPG) for diabetes screening are expected to improve the ability to detect persons with or at high risk of diabetes. We assessed the diagnostic and predictive capacity for diabetes of Abnormal-A1C and Abnormal-FPG. We compared these to the combined use of the two measures to the single use of either measurement.
  
  
  METHODS
  We analysed 31 eligible cross-sectional or cohort studies that assessed diagnostic or predictive ability, respectively, by using lower A1C and FPG cutoff values than recommended by current diabetes criteria. Positive and negative likelihood ratios (LR+ and LR-) were calculated to assess the ability to confirm or exclude diabetes, respectively, on the basis of a bivariate random-effects model.
  
  
  RESULTS
  With both Abnormal-A1C and Abnormal-FPG, the pooled LR+ was above 4 for diagnosing diabetes and above 3 for predicting diabetes. However, the pooled LR- for predicting diabetes was higher with Abnormal-A1C (0.48) and Abnormal-FPG (0.49) in comparison with that for diagnosing diabetes (0.27, Abnormal-A1C ; 0.28, Abnormal-FPG). In eight studies that assessed the predictive ability of the combination of A1C and FPG, using either Abnormal-A1C or Abnormal-FPG could lower LR- to 0.17 from 0.43 for only Abnormal-A1C and from 0.38 for only Abnormal-FPG. Accordingly, LR+ was also lowered to 2.37 from 3.36 for only Abnormal-A1C and from 3.84 for only-Abnormal-FPG.
  
  
  CONCLUSIONS
  The use of the two blood glucose tests had insufficient capacity to identify subjects at high risk for diabetes but had considerable capacity to identify undiagnosed diabetes.
authors: Department of Health Management Center, Mito Kyodo General Hospital, Ibaraki, Japan; Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan.
authors: Satoru
authors: S
authors: Kodama
authors: Chika
authors: C
authors: Horikawa
authors: Kazuya
authors: K
authors: Fujihara
authors: Reiko
authors: R
authors: Hirasawa
authors: Yoko
authors: Y
authors: Yachi
authors: Sakiko
authors: S
authors: Yoshizawa
authors: Shiro
authors: S
authors: Tanaka
authors: Yasuko
authors: Y
authors: Sone
authors: Hitoshi
authors: H
authors: Shimano
authors: Kaoruko Tada
authors: KT
authors: Iida
authors: Kazumi
authors: K
authors: Saito
authors: Hirohito
authors: H
authors: Sone
mesh_terms: D001786:Blood Glucose / Q000032:analysis; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000175:diagnosis*; D005215:Fasting / Q000097:blood; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D011236:Prediabetic State / Q000097:blood* / Q000175:diagnosis*; D011237:Predictive Value of Tests
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin
keywords: blood glucose; diagnosis; haemoglobin A, glycosylated; hyperglycemia; mass screening; meta-analysis