title: The 1-hour post-load glucose level is more effective than HbA1c for screening dysglycemia.
abstract: OBJECTIVE
  To assess the performance of HbA1c and the 1-h plasma glucose (PG ≥ 155 mg/dl; 8.6 mmol/l) in identifying dysglycemia based on the oral glucose tolerance test (OGTT) from a real-world clinical care setting.
  
  
  METHODS
  This was a diagnostic test accuracy study. For this analysis, we tested the HbA1c diagnostic criteria advocated by the American Diabetes Association (ADA 5.7-6.4 %) and International Expert Committee (IEC 6.0-6.4 %) against conventional OGTT criteria. We also tested the utility of 1-h PG ≥ mg/dl; 8.6 mmol/l. Prediabetes was defined according to ADA-OGTT guidelines. Spearman correlation tests were used to determine the relationships between HbA1c, 1-h PG with fasting, 2-h PG and indices of insulin sensitivity and β-cell function. The levels of agreement between diagnostic methods were ascertained using Cohen's kappa coefficient (Κ). Receiver operating characteristic (ROC) curve was used to analyze the performance of the HbA1c and 1-h PG test in identifying prediabetes considering OGTT as reference diagnostic criteria. The diagnostic properties of different HbA1c thresholds were contrasted by determining sensitivity, specificity and likelihood ratios (LR).
  
  
  RESULTS
  Of the 212 high-risk individuals, 70 (33 %) were identified with prediabetes, and 1-h PG showed a stronger association with 2-h PG, insulin sensitivity index, and β-cell function than HbA1c (P < 0.05). Furthermore, the level of agreement between 1-h PG ≥ 155 mg/dl (8.6 mmol/l) and the OGTT (Κ[95 % CI]: 0.40[0.28-0.53]) diagnostic test was stronger than that of ADA-HbA1c criteria 0.1[0.03-0.16] and IEC criteria (0.17[0.04-0.30]). The ROC (AUC[95 % CI]) for HbA1c and 1-h PG were 0.65[0.57-0.73] and 0.79[0.72-0.85], respectively. Importantly, 1-h PG ≥ 155 mg/dl (8.6 mmol/l) showed good sensitivity (74.3 % [62.4-84.0]) and specificity 69.7 % [61.5-77.1]) with a LR of 2.45. The ability of 1-h PG to discriminate prediabetes was better than that of HbA1c (∆AUC: -0.14; Z value: 2.5683; P = 0.01022).
  
  
  CONCLUSIONS
  In a real-world clinical practice setting, the 1-h PG ≥ 155 mg/dl (8.6 mmol/l) is superior for detecting high-risk individuals compared with HbA1c. Furthermore, HbA1c is a less precise correlate of insulin sensitivity and β-cell function than the 1-h PG and correlates poorly with the 2-h PG during the OGTT.
authors.affiliation: NYU School of Medicine, Department of Population Health, Center for Healthful Behavior Change, New York, NY, USA.
authors.forename: Ram
authors.initials: R
authors.lastname: Jagannathan
authors.affiliation: NYU School of Medicine, Department of Population Health, Center for Healthful Behavior Change, New York, NY, USA.
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Sevick
authors.affiliation: NYU School of Medicine, Department of Medicine, Division of Endocrinology and Metabolism, NYU Langone Diabetes Prevention Program, 530 First Avenue, Schwartz East, Suite 5E, New York, NY, 10016, USA.
authors.forename: Dorothy
authors.initials: D
authors.lastname: Fink
authors.affiliation: Unit for Cardiovascular Epidemiology, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, 52621, Israel.|The Feinstein Institute for Medical Research, Manhasset, North Shore, NY, 11030, USA.|Sackler Faculty of Medicine, School of Public Health, Department of Epidemiology and Preventive Medicine, Tel Aviv University, Ramat Aviv, 69978, Tel Aviv, Israel.
authors.forename: Rachel
authors.initials: R
authors.lastname: Dankner
authors.affiliation: Unit for Cardiovascular Epidemiology, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, 52621, Israel.
authors.forename: Angela
authors.initials: A
authors.lastname: Chetrit
authors.affiliation: The Feinstein Institute for Medical Research, Manhasset, North Shore, NY, 11030, USA.
authors.forename: Jesse
authors.initials: J
authors.lastname: Roth
authors.affiliation: Service d'Endocrinologie et Nutrition Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium.
authors.forename: Martin
authors.initials: M
authors.lastname: Buysschaert
authors.affiliation: NYU School of Medicine, Department of Medicine, Division of Endocrinology and Metabolism, NYU Langone Diabetes Prevention Program, 530 First Avenue, Schwartz East, Suite 5E, New York, NY, 10016, USA. michael.bergman@nyumc.org.
authors.forename: Michael
authors.initials: M
authors.lastname: Bergman
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D005215:Fasting; D005260:Female; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000175:diagnosis*; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D011236:Prediabetic State / Q000097:blood / Q000175:diagnosis*; D012372:ROC Curve; D012306:Risk; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin
keywords: 1-hour post-load glucose; Diabetes prevention; Dysglycemia; HbA1c; OGTT; Prediabetes