Elevated HbA1c and fasting plasma glucose in predicting diabetes incidence among older adults

Are two better than one?

Kasia J. Lipska, Silvio E. Inzucchi, Peter H. Van Ness, Thomas M. Gill, Alka Kanaya, Elsa S. Strotmeyer, Annemarie Koster, Karen Johnson, Bret H. Goodpaster, Tamara Harris, Nathalie De Rekeneire

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Objective-To determine which measuresdimpaired fasting glucose (IFG), elevated HbA1c, or bothdbest predict incident diabetes in older adults. RESEARCH DESIGN ANDMETHODSdFrom the Health, Aging, and Body Composition study, we selected individuals without diabetes, and we defined IFG (100-125 mg/dL) and elevated HbA1c (5.7-6.4%) per American Diabetes Association guidelines. Incident diabetes was based on self-report, use of antihyperglycemic medicines, or HbA1c ≥6.5% during 7 years of follow-up. Logistic regression analyses were adjusted for age, sex, race, site, BMI, smoking, blood pressure, and physical activity. Discrimination and calibration were assessed formodels with IFG and with both IFG and elevated HbA1c. Results-Among 1,690 adults (mean age 76.5, 46% men, 32% black), 183 (10.8%) developed diabetes over 7 years. Adjusted odds ratios of diabetes were 6.2 (95% CI 4.4-8.8) in those with IFG (versus those with fasting plasma glucose [FPG] <100 mg/dL) and 11.3 (7.8-16.4) in those with elevated HbA1c (versus those with HbA1c <5.7%). When FPG and HbA1c were considered together, odds ratios were 3.5 (1.9-6.3) in those with IFG only, 8.0 (4.8-13.2) in those with elevated HbA1c only, and 26.2 (16.3-42.1) in those with both IFG and elevated HbA1c (versus those with normal FPG and HbA1c). Addition of elevated HbA1c to themodel with IFG resulted in improved discrimination and calibration. Conclusions-Older adults with both IFG and elevated HbA 1c have a substantially increased odds of developing diabetes over 7 years. Combined screening with FPG and HbA1c may identify older adults at very high risk for diabetes.

Original languageEnglish (US)
Pages (from-to)3923-3929
Number of pages7
JournalDiabetes care
Volume36
Issue number12
DOIs
StatePublished - Dec 1 2013

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Fasting
Glucose
Incidence
Calibration
Odds Ratio
Body Composition
Hypoglycemic Agents
Self Report
Logistic Models
Smoking
Regression Analysis
Guidelines
Exercise
Blood Pressure
Health

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

Cite this

Lipska, K. J., Inzucchi, S. E., Van Ness, P. H., Gill, T. M., Kanaya, A., Strotmeyer, E. S., ... De Rekeneire, N. (2013). Elevated HbA1c and fasting plasma glucose in predicting diabetes incidence among older adults: Are two better than one? Diabetes care, 36(12), 3923-3929. https://doi.org/10.2337/dc12-2631

Elevated HbA1c and fasting plasma glucose in predicting diabetes incidence among older adults : Are two better than one? / Lipska, Kasia J.; Inzucchi, Silvio E.; Van Ness, Peter H.; Gill, Thomas M.; Kanaya, Alka; Strotmeyer, Elsa S.; Koster, Annemarie; Johnson, Karen; Goodpaster, Bret H.; Harris, Tamara; De Rekeneire, Nathalie.

In: Diabetes care, Vol. 36, No. 12, 01.12.2013, p. 3923-3929.

Research output: Contribution to journalArticle

Lipska, KJ, Inzucchi, SE, Van Ness, PH, Gill, TM, Kanaya, A, Strotmeyer, ES, Koster, A, Johnson, K, Goodpaster, BH, Harris, T & De Rekeneire, N 2013, 'Elevated HbA1c and fasting plasma glucose in predicting diabetes incidence among older adults: Are two better than one?', Diabetes care, vol. 36, no. 12, pp. 3923-3929. https://doi.org/10.2337/dc12-2631
Lipska, Kasia J. ; Inzucchi, Silvio E. ; Van Ness, Peter H. ; Gill, Thomas M. ; Kanaya, Alka ; Strotmeyer, Elsa S. ; Koster, Annemarie ; Johnson, Karen ; Goodpaster, Bret H. ; Harris, Tamara ; De Rekeneire, Nathalie. / Elevated HbA1c and fasting plasma glucose in predicting diabetes incidence among older adults : Are two better than one?. In: Diabetes care. 2013 ; Vol. 36, No. 12. pp. 3923-3929.
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abstract = "Objective-To determine which measuresdimpaired fasting glucose (IFG), elevated HbA1c, or bothdbest predict incident diabetes in older adults. RESEARCH DESIGN ANDMETHODSdFrom the Health, Aging, and Body Composition study, we selected individuals without diabetes, and we defined IFG (100-125 mg/dL) and elevated HbA1c (5.7-6.4{\%}) per American Diabetes Association guidelines. Incident diabetes was based on self-report, use of antihyperglycemic medicines, or HbA1c ≥6.5{\%} during 7 years of follow-up. Logistic regression analyses were adjusted for age, sex, race, site, BMI, smoking, blood pressure, and physical activity. Discrimination and calibration were assessed formodels with IFG and with both IFG and elevated HbA1c. Results-Among 1,690 adults (mean age 76.5, 46{\%} men, 32{\%} black), 183 (10.8{\%}) developed diabetes over 7 years. Adjusted odds ratios of diabetes were 6.2 (95{\%} CI 4.4-8.8) in those with IFG (versus those with fasting plasma glucose [FPG] <100 mg/dL) and 11.3 (7.8-16.4) in those with elevated HbA1c (versus those with HbA1c <5.7{\%}). When FPG and HbA1c were considered together, odds ratios were 3.5 (1.9-6.3) in those with IFG only, 8.0 (4.8-13.2) in those with elevated HbA1c only, and 26.2 (16.3-42.1) in those with both IFG and elevated HbA1c (versus those with normal FPG and HbA1c). Addition of elevated HbA1c to themodel with IFG resulted in improved discrimination and calibration. Conclusions-Older adults with both IFG and elevated HbA 1c have a substantially increased odds of developing diabetes over 7 years. Combined screening with FPG and HbA1c may identify older adults at very high risk for diabetes.",
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