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KMID : 1138720120380020041
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Korean Public Health Research
2012 Volume.38 No. 2 p.41 ~ p.47
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Evaluation of HbA1c as a Screening for Type 2 Diabetes Mellitus in Korea
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Kim Ji-Hun
Oh Myueng-Guen
Han Mi-Ah
Han Sang-Tak
Lee Min-Suk
Kim Young-Il
Go Il-Woong
Lee Jung-Yun
Heo Gyoung-Suk
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Abstract
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Objectives: An HbA1c test result ≥ 6.5% has recently been recommended as the defining criterion for diabetes by the American Diabetes Association (ADA). The aim of the study was to assess the screening test properties of HbA1c for undiagnosed diabetes mellitus (DM) according to the ADA criteria.
Methods: Oral glucose tolerance test (OGTT) and HbA1c were performed among 163 subjects without previously diagnosed diabetes at Haenam General Hospital, Korea between January, 2005 and June, 2010. The OGTT is considered to be the gold standard for diagnosing diabetes. Based on a ROC curve, optimal sensitivity and specificity were derived for identifying the HbA1c threshold. The level of agreement (ĸ statistics) between OGTT and HbA1c were calculated.
Results: The prevalence of pre-diabetes and diabetes were 27.6% and 56.4%. The area under the receiver
operating characteristic curve for undiagnosed DM was low in HbA1c (0.814 [95% CI: 0.750?0.879]) compared to fasting plasma glucose (0.924 [0.884?0.964]) and 2-h plasma glucose (0.924 [0.884-0.964]). HbA1c of 6.5% gave a sensitivity of 70.7%, a specificity of 76.1%. The level of agreement between two diagnostic criteria was low (ĸ = 0.448).
Conclusion: The findings in this study demonstrate that the discordance between the OGTT and HbA1c criteria in the diagnosis of diabetes in some Koreans is large. The measurement of HbA1c alone may be inefficient to screen undiagnosed DM. Further large-scale, population-based studies are needed to evaluate the
HbA1c threshold for diagnosing diabetes in Korea.
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KEYWORD
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HbA1c protein, human, Oral glucose tolerance test, Glucose, Diabetes mellitus
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