Eddy S. Lang, MD
What are the optimal hemoglobin A1c (HbA1c) cutpoints to screen for undiagnosed diabetes and prediabetes in an emergency department (ED) setting?
Comparison of HbA1c levels obtained in the ED with follow-up fasting blood glucose (FBG) and 2-hour oral glucose tolerance tests (OGTTs).
An ED in Long Island, New York, USA.
A convenience sample of 618 adults (mean age 50 y, 56% men, 48% white, mean body mass index 29.2 kg/m2, 50% admitted to hospital) who had no known history of elevated glucose or diabetes and had plasma glucose drawn in the ED as part of routine medical work-up. Exclusion criteria were major acute trauma or burns, metastatic cancer, renal failure, hepatic failure, end-stage or debilitating illness, severe psychiatric illness, acute or chronic pancreatitis, sickle-cell disease or trait, chemotherapy in the past 6 months, systemic steroids in the past 4 weeks, or intravenous glucose or sympathomimetics before blood was drawn in the ED.
HbA1c, measured using the Tosoh GY (Tosoh Bioscience) high-performance liquid chromatography analyzer.
FBG and 2-hour OGTT assessed after recovery from acute illness. Participants were asked to increase carbohydrate intake the day before testing and fast overnight for ≥ 8 hours before testing. Results were assessed using American Diabetes Association criteria.
Sensitivity, specificity, likelihood ratios, and area under the receiver-operating characteristic (ROC) curve for detecting diabetes and prediabetes.
Prevalences of diabetes and prediabetes based on follow-up FBG and OGTT were 11% and 32%, respectively. Optimal cutpoints for detecting diabetes and prediabetes based on area under ROC curves were 6.0% and 5.7%, respectively (Table).
In an emergency department setting, the optimal HbA1c cutpoint to screen for diabetes was 6.0%, and the optimal cutpoint to screen for prediabetes was 5.7%.
*ROC = receiver-operating characteristic. Diagnostic terms defined in Glossary. Gold standard was follow-up fasting blood glucose and 2-h oral glucose tolerance test assessed after recovery from acute illness.
Lang ES. The optimal HbA1c cutpoint to screen for diabetes in the emergency department was 6.0%. Ann Intern Med. ;156:JC2–11. doi: 10.7326/0003-4819-156-4-201202210-02011
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Published: Ann Intern Med. 2012;156(4):JC2-11.
Cardiology, Coronary Risk Factors, Diabetes, Emergency Medicine, Endocrine and Metabolism.
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