title: Optimal Hemoglobin A1c Levels for Screening of Diabetes and Prediabetes in the Japanese Population.
abstract: The aim of this study was to evaluate the utility of hemoglobin A1c (HbA1c) to identify individuals with diabetes and prediabetes in the Japanese population. A total of 1372 individuals without known diabetes were selected for this study. A 75 g oral glucose tolerance test (OGTT) was used to diagnose diabetes and prediabetes. The ability of HbA1c to detect diabetes and prediabetes was investigated using receiver operating characteristic (ROC) analysis. The kappa (κ) coefficient was used to test the agreement between HbA1c categorization and OGTT-based diagnosis. ROC analysis demonstrated that HbA1c was a good test to identify diabetes and prediabetes, with areas under the curve of 0.918 and 0.714, respectively. Optimal HbA1c cutoffs for diagnosing diabetes and prediabetes were 6.0% (sensitivity 83.7%, specificity 87.6%) and 5.7% (sensitivity 60.6%, specificity 72.1%), respectively, although the cutoff for prediabetes showed low accuracy (67.6%) and a high false-negative rate (39.4%). Agreement between HbA1c categorization and OGTT-based diagnosis was low in diabetes (κ = 0.399) and prediabetes (κ = 0.324). In Japanese subjects, the HbA1c cutoff of 6.0% had appropriate sensitivity and specificity for diabetes screening, whereas the cutoff of 5.7% had modest sensitivity and specificity in identifying prediabetes. Thus, HbA1c may be inadequate as a screening tool for prediabetes.
authors.affiliation: Department of Internal Medicine, Iida Municipal Hospital, 438 Yawata-machi, Iida, Nagano 395-8502, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Shimodaira
authors.affiliation: Department of Internal Medicine, Iida Municipal Hospital, 438 Yawata-machi, Iida, Nagano 395-8502, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Okaniwa
authors.affiliation: Department of Internal Medicine, Iida Municipal Hospital, 438 Yawata-machi, Iida, Nagano 395-8502, Japan.
authors.forename: Norinao
authors.initials: N
authors.lastname: Hanyu
authors.affiliation: Division of Companion Diagnostics, Department of Pathology of Microbiology, Nihon University School of Medicine, 30-1 Ooyaguchi-kamimachi, Itabashi-ku, Tokyo 173-8610, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Nakayama
mesh_terms: D000368:Aged; D044466:Asian People; D001786:Blood Glucose / Q000378:metabolism*; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000378:metabolism; D005260:Female; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D007564:Japan; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D011236:Prediabetic State / Q000175:diagnosis* / Q000378:metabolism; D012372:ROC Curve; D012680:Sensitivity and Specificity
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human