Open AccessRe‐examining the sensitivity of HbA1c to screen for diabetes mellitus
Author(s) -
Yap Chun W.,
Ang Yee G.,
Quek Timothy P.L.,
Heng Bee H.,
Chew Daniel E.K.
Publication year - 2018
Publication title -
journal of diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.949
H-Index - 43
eISSN - 1753-0407
pISSN - 1753-0393
DOI - 10.1111/1753-0407.12615
Subject(s) - medicine , diabetes mellitus , receiver operating characteristic , plasma glucose , population , retrospective cohort study , tertiary care , endocrinology , environmental health
Background One of the laboratory tests recommended by the American Diabetes Association (ADA) to screen for diabetes mellitus (DM) is HbA1c, and it is particularly suitable for segments of the population that cannot or are unwilling to fast for a screening test. The aim of this study was to determine whether HbA1c would be a useful tool to screen for DM in a real‐world setting if ADA guidelines for repeat testing to confirm the diagnosis of DM are strictly adhered to. Methods A retrospective database study was performed by extracting demographic and laboratory data from a chronic disease registry that collects data on adults from three tertiary hospitals and nine large primary care clinics in Singapore. Data were extracted and analyzed for adults not previously known to have DM whose data was captured in the registry between 2005 and 2016 with HbA1c and at least two diagnostic tests for DM (fasting plasma glucose or 2‐h plasma glucose) performed within 4 weeks after HbA1c determination. Results In all, 3928 adults were included in this study. The sensitivity, specificity, and area under the receiver operating characteristic curve for HbA1c at a threshold of 6.5% were 85.2%, 82.3%, and 0.914, respectively. A higher sensitivity was found in female adults, younger adults, and those of non‐Chinese ethnicity. Conclusions The sensitivity of HbA1c as a screening test for DM in this study was significantly higher than that reported previously. This work provides additional evidence supporting the inclusion of HbA1c as one of the screening tests for DM.