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    The Role Of Hba1C Testing In Diagnosing Diabetes: 종 설 (Review)

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    The document discusses the role of HbA1C testing in diagnosing diabetes. It notes that approximately 30% of people with diabetes may be undiagnosed. The use of HbA1C for diagnosis has several advantages over traditional glucose-based tests as it does not require fasting and provides a measure of long-term glycemic control. International expert committees have recently recommended using an HbA1C level of 6.5% or higher as the diagnostic threshold for diabetes. Studies have shown that the use of HbA1C criteria may improve diabetes detection rates and more accurately identify those at high risk compared to glucose criteria alone. However, some limitations of HbA1C for diagnosis include low sensitivity and risk of

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    The Role Of Hba1C Testing In Diagnosing Diabetes: 종 설 (Review)

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    Choi Won
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    The document discusses the role of HbA1C testing in diagnosing diabetes. It notes that approximately 30% of people with diabetes may be undiagnosed. The use of HbA1C for diagnosis has several advantages over traditional glucose-based tests as it does not require fasting and provides a measure of long-term glycemic control. International expert committees have recently recommended using an HbA1C level of 6.5% or higher as the diagnostic threshold for diabetes. Studies have shown that the use of HbA1C criteria may improve diabetes detection rates and more accurately identify those at high risk compared to glucose criteria alone. However, some limitations of HbA1C for diagnosis include low sensitivity and risk of

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    The document discusses the role of HbA1C testing in diagnosing diabetes. It notes that approximately 30% of people with diabetes may be undiagnosed. The use of HbA1C for diagnosis has several advantages over traditional glucose-based tests as it does not require fasting and provides a measure of long-term glycemic control. International expert committees have recently recommended using an HbA1C level of 6.5% or higher as the diagnostic threshold for diabetes. Studies have shown that the use of HbA1C criteria may improve diabetes detection rates and more accurately identify those at high risk compared to glucose criteria alone. However, some limitations of HbA1C for diagnosis include low sensitivity and risk of

    Copyright:

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    35 views5 pages

    The Role Of Hba1C Testing In Diagnosing Diabetes: 종 설 (Review)

    Uploaded by

    Choi Won
    The document discusses the role of HbA1C testing in diagnosing diabetes. It notes that approximately 30% of people with diabetes may be undiagnosed. The use of HbA1C for diagnosis has several advantages over traditional glucose-based tests as it does not require fasting and provides a measure of long-term glycemic control. International expert committees have recently recommended using an HbA1C level of 6.5% or higher as the diagnostic threshold for diabetes. Studies have shown that the use of HbA1C criteria may improve diabetes detection rates and more accurately identify those at high risk compared to glucose criteria alone. However, some limitations of HbA1C for diagnosis include low sensitivity and risk of

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    : 79 5 2010

    (Review)

    A1C

    The role of HbA1C testing in diagnosing diabetes


    Hyejin Lee, M.D., Ph.D.
    Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea

    Diabetes is often not diagnosed until complications appear, and approximately 30% of people with diabetes may be undiagnosed.
    Also, complications of diabetes have become a leading cause of impairment of life quality. Therefore efficient approaches to
    diagnosing diabetes should be developed.
    The most widely used test for diagnosis of diabetes includes fasting plasma glucose (FPG) and the oral glucose tolerance test
    (OGTT). The international expert committee has recently recommended the use of HbA1C assay to diagnose diabetes, with a
    threshold of 6.5%. In 2010, the American Diabetes Association (ADA) adopted the proposal and it became part of the diagnostic
    criteria of diabetes in the 2010 Clinical Practice Recommendations. Previously, HbA1C had been used primarily to monitor
    glycemic control among individuals with diabetes. However, over the last decade, the HbA1C measurement has become standardized, facilitating its recognition as an acceptable diagnostic method for diabetes. And several practical considerations favor the
    use of HbA1C in diagnosing diabetes. The HbA1C does not require the patient to be fasting, can be done at any time that a visit is
    scheduled, is simpler to perform than the 2 hr OGTT, and is less dependent on the patients health status at the moment of the blood
    draw. Also HbA1C is less sensitive to several preanalytical variables, and biological variability is lower than that of both 2 hr
    post-load glucose and FPG. However, this advantage must be balanced by the low sensitivity of HbA1C, the limited standardization
    of HbA1C in certain regions, the incomplete correlation between HbA1C and glucose, and risk of misdiagnosis in patient with
    increased red blood cell turnover, end stage renal disease, with certain forms of hemoglobinopathies. (Korean J Med 79:495-499, 2010)
    Key Words: HbA1C; Diabetes

    ,
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    NDDG)

    140 mg/dL 75 g 2

    200 mg/dL ,

    - 495 -

    The Korean Journal of Medicine: Vol. 79, No. 5, 2010

    140 mg/dL 2

    , A1C 6.5%

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    (International Expert Committee)

    2010 , national health and nutrition

    126 mg/dL

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    110
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    6).

    ( 1)3). Endocrine Society American


    Association of Clinical Endocrinologists (AACE)

    A1C

    4)
    .

    126 mg/dL

    A1C

    Table 1. Criteria for the diagnosis of diabetes3)


    1. A1C 6.5%. The test should be performed in a laboratory using a method that is NGSP certified and standardized to the DCCT assay
    OR
    2. FPG 126 mg/dL. Fasting is defined as no caloric intake for at least 8h.
    OR
    3. 2-h plasma glucose 200 mg/dL during an OGTT. The test should be performed as described by the World Health Organization, using
    a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water
    OR
    4. In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose 200 mg/dL
    NGSP, national glycohemoglobin standardization program; DCCT, diabetes control and complications trial; FPG, fasting plasma glucose; OGTT, oral glucose tolerance test.
    - 496 -

    Hyejin Lee. The role of HbA1C testing in diagnosing diabetes

    45% 61% .

    A1C

    ROC (Receiver Operation Characteristic)

    . 1997

    Curve

    A1C

    A1C , cutoff value A1C

    , 2003 National Glycohe-

    5.9, 6.1, 6.2%

    moglobin Standardization Program (NGSP)

    76~95%, 67~86%,

    A1C

    A1C 6.1% 78~81%, 79~84%,

    7)

    13-18)

    . A1C 5.9%

    A1C .

    A1C 6.2% 43~81%, 88~99%

    19-23). 2006~2007 Netherlands Hoorn 40~65

    , ,

    6,180 random sample

    A1C, , 2

    A1C

    A1C

    . A1C , 2

    . ,

    0.46, 0.33 ,

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    . ROC curve

    . , A1C

    (72%) (91%) A1C

    5.8%, HbA1C > 6.5% 24% 99%

    , ,

    24).

    . ,

    NHANES III A1C 3SD

    A1C ,

    6.5% 99.6% 43~44%

    1,3,7,25,26),

    , , .

    . A1C

    A1C


    A1C

    8)

    . Petersen 12~15%

    2009 , 75 g

    A1C 1.9% ,

    9)

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    A1C . 8

    A1C 2% .

    1,000

    2
    11)

    , 2, A1C .

    A1C Bennett ,

    ROC curve ,

    A1C (cut points: 6.2%)

    A1C

    (126 mg/dL)

    6.1%, 84.8%, 82.3%.

    , A1C

    , 6.1%, 6.2%,

    12)

    . Rohlfing 2002 NHANES III

    , 20 5.9%, 30~40 6.1%, 50

    6.2%, 60 6.3% A1C

    A1C 6.1% . Perry

    100~125 mg/dL

    A1C 6.5% 97.5%,

    A1C 6.1% ,

    59.0%, .

    - 497 -

    : 79 5 603 2010

    A1C 6.5% , 75 g

    . ,

    68.1%,

    96.0%, A1C 6.1%

    A1C . , A1C

    27)

    , 36.1%, 97.9% .

    3 4,600

    . A1C

    A1C 6.1%.

    69.4 2,107

    , A1C , 198

    28)

    , A1C 6.5%

    A1C .
    ,

    44%, 79%

    4). (63%)

    A1C

    (60%) A1C 6.15%,

    1/3 .

    A1C ,

    A1C . ADOPT Study Group

    African-Americans Caucasians A1C

    A1C 6.5% . ,

    0.4~0.7% ,

    , A1C 6.1%

    A1C 1~1.5% ,

    29,30). ,

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    salicylate, vitamins C, E A1C

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    . A1C
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    : A1C;
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    S C CV 10% ,
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    D
    . , ,
    , , ,
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    A1C , A1C
    - 498 -

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