Reproducibility of a prediabetes classification in a contemporary population

Chhavi Chadha; Anastassios G Pittas; Christine W Lary; William C Knowler; Ranee Chatterjee; Lawrence S Phillips; Vanita R Aroda; Michael R Lewis; Richard Pratley; Myrlene A Staten; Jason Nelson; Neda Rasouli; Irwin Brodsky; D2d Research Group

doi:10.1016/j.metop.2020.100031

Reproducibility of a prediabetes classification in a contemporary population

Metabol Open. 2020 Mar 7:6:100031. doi: 10.1016/j.metop.2020.100031. eCollection 2020 Jun.

Authors

Affiliations

¹ HealthPartners Institute, 8170 33rd Ave S, Bloomington, MN 55425, USA.
² Tufts Medical Center, 800 Washington Street, Box #268, Boston, MA, 02111, USA.
³ Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, 509 Forest Avenue, Suite 200, Portland, ME, 04101, USA.
⁴ National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ, USA.
⁵ Duke University, Division of General Internal Medicine, 200 Morris Street, 3rd Floor, Durham, NC, 27701, USA.
⁶ Atlanta VA Medical Center, 1670 Clairmont Rd, 151CSC, Decatur, GA, 30033, USA.
⁷ Emory University School of Medicine, 201 Dowman Drive, Atlanta, GA, 30322, USA.
⁸ MedStar Health Research Institute, 6525 Belcrest Road, #700, Hyattsville, MD, 20782, USA.
⁹ Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, VT, 05405, USA.
¹⁰ Advent Health Translational Research Institute for Metabolism and Diabetes, 301 East Princeton Street, Orlando, FL, 32804, USA.
¹¹ National Institute of Diabetes and Digestive and Kidney Diseases, 6701 Democracy Boulevard, Bethesda, MD, 20892, USA.
¹² University of Colorado, School of Medicine, 13001 E 17th Place, Aurora, CO, 80045, USA.
¹³ VA Eastern Colorado Health Care System, Rocky Mountain Regional VAMC, 1700 N Wheeling Street, Aurora, CO, 80045, USA.
¹⁴ Maine Medical Partners Endocrinology and Diabetes Center, 175 US Route 1, Scarborough, ME, 04074, USA.

Abstract

Aims: To assess whether meeting both fasting plasma glucose (FPG) and HbA1c criteria for prediabetes in people at high risk indicates with near certainty the presence of dysglycemia on repeat testing.

Methods: Observational study using data from Vitamin D and Type 2 Diabetes (D2d) study. HbA1c, FPG were measured at screening visit 1; FPG, HbA1c and 2 h plasma glucose (2hPG) measured at screening visit 2 (a median of 21 days later); participants classified as having normal glucose regulation (all 3 tests in normal range), prediabetes or diabetes (at least 1 of 3 tests in diabetes range). A predictive model was developed to estimate the probability of confirming dysglycemia and for detecting diabetes at screening visit 2 based on values of FPG and HbA1c at screening visit 1.

Results: Of 1271 participants who met both FPG and HbA1c criteria for prediabetes at screening visit 1, 98.6% exhibited dysglycemia (defined as prediabetes or diabetes) on repeat testing (84.5% were classified as having prediabetes, 14.1% were reclassified as having diabetes). Of those with diabetes, 62.6% were identified by 2hPG alone.

Conclusions: Combined measurement of FPG and HbA1c is a reliable and reproducible measure to identify presence of dysglycemia among people at high risk. A prediction model is provided to help clinicians decide whether an oral glucose tolerance test will provide value in detecting diabetes based on the 2hPG criterion.

Keywords: Diabetes; Dysglycemia; FPG; HbA1c; Oral glucose tolerance testing; Prediabetes.