title: The cutoffs and performance of glycated hemoglobin for diagnosing diabetes and prediabetes in a young and middle-aged population and in an elderly population.
abstract: The aims were to compare the appropriate cutoffs of glycated hemoglobin (HbA1c) in a population of varying ages and to evaluate the performance of HbA1c for diagnosing diabetes and prediabetes. A total of 1064 participants in the young and middle-aged group and 1671 in the elderly group were included and underwent HbA1c testing and an oral glucose tolerance test (OGTT). Sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were calculated to evaluate the optimal HbA1c cutoffs. Kappa coefficients were used to test for agreement between HbA1c categorization and OGTT-based diagnoses. The optimal HbA1c cutoffs for diagnosing diabetes were 5.7% (39 mmol/mol) in the young and middle-aged group with a sensitivity of 66.7%, specificity of 86.7%, and AUC of 0.821 (95% CI: 0.686, 0.955) and 5.9% (41 mmol/mol) in the elderly group with a sensitivity of 80.4%, specificity of 73.3%, and AUC of 0.831 (0.801, 0.861). The optimal cutoffs for diagnosing prediabetes were 5.6% (38 mmol/mol) and 5.7% (39 mmol/mol) in the young and middle-aged group and in the elderly group, respectively. Agreement between the OGTT-based diagnosis of diabetes or prediabetes and the optimal HbA1c cutoff was low (all kappa coefficients <0.4). The combination of HbA1c and fasting plasma glucose increased diagnostic sensitivities or specificities. In conclusion, age-specific HbA1c cutoffs for diagnosing diabetes or prediabetes were appropriate. Furthermore, the performance of HbA1c for diagnosing diabetes and prediabetes was poor. HbA1c should be used in combination with traditional glucose criteria when detecting and diagnosing diabetes or prediabetes.
authors.affiliation: Department of Geriatric Endocrinology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China.
authors.forename: Shuang-Tong
authors.initials: ST
authors.lastname: Yan
authors.affiliation: Department of Geriatric Endocrinology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China.
authors.forename: Hai-Ying
authors.initials: HY
authors.lastname: Xiao
authors.affiliation: Department of Geriatric Endocrinology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China. Electronic address: tianhui@medmail.com.cn.
authors.forename: Hui
authors.initials: H
authors.lastname: Tian
authors.affiliation: Department of Geriatric Endocrinology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China.
authors.forename: Chun-Lin
authors.initials: CL
authors.lastname: Li
authors.affiliation: Department of Geriatric Endocrinology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China.
authors.forename: Fu-Sheng
authors.initials: FS
authors.lastname: Fang
authors.affiliation: Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing 100853, China.
authors.forename: Xiao-Ying
authors.initials: XY
authors.lastname: Li
authors.affiliation: Department of Geriatric Endocrinology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China.
authors.forename: Xiao-Ling
authors.initials: XL
authors.lastname: Cheng
authors.affiliation: Department of Geriatric Endocrinology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China.
authors.forename: Nan
authors.initials: N
authors.lastname: Li
authors.affiliation: Department of Geriatric Endocrinology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China.
authors.forename: Xin-Yu
authors.initials: XY
authors.lastname: Miao
authors.affiliation: Department of Geriatric Endocrinology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Department of Geriatric Endocrinology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China.
authors.forename: Liang-Chen
authors.initials: LC
authors.lastname: Wang
authors.affiliation: Laboratory of Endocrinology, Chinese PLA General Hospital, Beijing 100853, China.
authors.forename: Xiao-Man
authors.initials: XM
authors.lastname: Zou
authors.affiliation: Laboratory of Endocrinology, Chinese PLA General Hospital, Beijing 100853, China.
authors.forename: Fang-Ling
authors.initials: FL
authors.lastname: Ma
authors.affiliation: Institute of Geriatrics, Chinese PLA General Hospital, Beijing 100853, China.
authors.forename: Yao
authors.initials: Y
authors.lastname: He
authors.affiliation: Institute of Geriatrics, Chinese PLA General Hospital, Beijing 100853, China.
authors.forename: Xiao-Yong
authors.initials: XY
authors.lastname: Sai
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D002681:China / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011236:Prediabetic State / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D012372:ROC Curve; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin
keywords: Diabetes; Diagnosis; Glycated hemoglobin; Prediabetes