Skip to main content
  • More from ADA
    • Diabetes
    • Clinical Diabetes
    • Diabetes Spectrum
    • ADA Standards of Medical Care
    • ADA Scientific Sessions Abstracts
    • BMJ Open Diabetes Research & Care
  • Subscribe
  • Log in
  • My Cart
  • Follow ada on Twitter
  • RSS
  • Visit ada on Facebook
Diabetes Care

Advanced Search

Main menu

  • Home
  • Current
    • Current Issue
    • Online Ahead of Print
    • Special Article Collections
    • ADA Standards of Medical Care
  • Browse
    • By Topic
    • Issue Archive
    • Saved Searches
    • Special Article Collections
    • ADA Standards of Medical Care
  • Info
    • About the Journal
    • About the Editors
    • ADA Journal Policies
    • Instructions for Authors
    • Guidance for Reviewers
  • Reprints/Reuse
  • Advertising
  • Subscriptions
    • Individual Subscriptions
    • Institutional Subscriptions and Site Licenses
    • Access Institutional Usage Reports
    • Purchase Single Issues
  • Alerts
    • E­mail Alerts
    • RSS Feeds
  • Podcasts
    • Diabetes Core Update
    • Special Podcast Series: Therapeutic Inertia
    • Special Podcast Series: Influenza Podcasts
    • Special Podcast Series: SGLT2 Inhibitors
    • Special Podcast Series: COVID-19
  • Submit
    • Submit a Manuscript
    • Journal Policies
    • Instructions for Authors
    • ADA Peer Review
  • More from ADA
    • Diabetes
    • Clinical Diabetes
    • Diabetes Spectrum
    • ADA Standards of Medical Care
    • ADA Scientific Sessions Abstracts
    • BMJ Open Diabetes Research & Care

User menu

  • Subscribe
  • Log in
  • My Cart

Search

  • Advanced search
Diabetes Care
  • Home
  • Current
    • Current Issue
    • Online Ahead of Print
    • Special Article Collections
    • ADA Standards of Medical Care
  • Browse
    • By Topic
    • Issue Archive
    • Saved Searches
    • Special Article Collections
    • ADA Standards of Medical Care
  • Info
    • About the Journal
    • About the Editors
    • ADA Journal Policies
    • Instructions for Authors
    • Guidance for Reviewers
  • Reprints/Reuse
  • Advertising
  • Subscriptions
    • Individual Subscriptions
    • Institutional Subscriptions and Site Licenses
    • Access Institutional Usage Reports
    • Purchase Single Issues
  • Alerts
    • E­mail Alerts
    • RSS Feeds
  • Podcasts
    • Diabetes Core Update
    • Special Podcast Series: Therapeutic Inertia
    • Special Podcast Series: Influenza Podcasts
    • Special Podcast Series: SGLT2 Inhibitors
    • Special Podcast Series: COVID-19
  • Submit
    • Submit a Manuscript
    • Journal Policies
    • Instructions for Authors
    • ADA Peer Review
Epidemiology/Health Services/Psychosocial Research

Using HbA1c to Improve Efficacy of the American Diabetes Association Fasting Plasma Glucose Criterion in Screening for New Type 2 Diabetes in American Indians

The Strong Heart Study

  1. Wenyu Wang, PHD1,
  2. Elisa T. Lee, PHD1,
  3. Richard Fabsitz, MA2,
  4. Thomas K. Welty, MD, MPH3 and
  5. Barbara V. Howard, PHD4
  1. 1College of Public Health, University of Oklahoma, Health Sciences Center, Oklahoma City, Oklahoma
  2. 2National Heart, Lung and Blood Institute, Bethesda, Maryland
  3. 3Aberdeen Area Tribal Chairmen’s Health Board, Aberdeen, South Dakota
  4. 4Medlantic Research Institute, Washington, DC
    Diabetes Care 2002 Aug; 25(8): 1365-1370. https://doi.org/10.2337/diacare.25.8.1365
    PreviousNext
    • Article
    • Figures & Tables
    • Info & Metrics
    • PDF
    Loading

    The Strong Heart Study

    Abstract

    OBJECTIVE—To find an optimal critical line in the fasting plasma glucose (FPG)-HbA1c plane for identifying diabetes in participants with impaired fasting glucose (IFG) and thereby improve the efficacy of using FPG alone in diabetes screening among American Indians.

    RESEARCH DESIGN AND METHODS—We used FPG, 2-h postload glucose (2hPG), and HbA1c measured in the 2,389 American Indians (aged 45–74 years, without diabetes treatment or prior history of diabetes) in the Strong Heart Study (SHS) baseline (second) examination. Participants were classified as having diabetes if they had either FPG ≥126 mg/dl or 2hPG ≥200 mg/dl, as having IFG if they had 110 ≤ FPG < 126 mg/dl, and as having normal fasting glucose (NFG) if they had FPG <110, according to the American Diabetes Association (ADA) definition. Logistic regression models were used for identifying diabetes (2hPG ≥200 mg/dl) in IFG participants. The areas under the receiver operating characteristic (ROC) curves generated by different logistic regression models were evaluated and compared to select the best model. A utility function based on the best model and the cost-to-benefit ratio was used to find the optimal critical line. The data from the second examination were used to study the effect of the time interval between the successive diabetes screenings on both the FPG criterion and the optimal critical line.

    RESULTS—A total of 37% of all subjects with new diabetes at baseline and 55.2% of those in the second exam had 2hPG ≥200 but FPG <126. There was a very large portion of IFG participants with diabetes (19.3 and 22.9% in the baseline and second exam, respectively). Among the areas under the ROC curves, the area generated by the logistic regression model on FPG plus HbA1c is the largest and is significantly larger than that based on FPG (P = 0.0008). For a cost-to-benefit ratio of 0.23888, the optimal critical line that has the highest utility is: 0.89 × HbA1c + 0.11 × FPG = 17.92. Those IFG participants whose FPG and HbA1c were above or on the line were referred to take an oral glucose tolerance test (OGTT) to diagnose diabetes. The optimal critical line is lower if a successive diabetes screening will be conducted 4 years after the previous screening.

    CONCLUSIONS—FPG ≥126 and 2hPG ≥200, as suggested by the ADA, are used independently to define diabetes. The FPG level is easy to obtain, and using FPG alone is suggested for diabetes screening. It is difficult to get physicians and patients to perform an OGTT to get a 2hPG level because of the many drawbacks of the OGTT, especially in those patients who already have FPG <126. It is also impractical to conduct an OGTT for everyone in a diabetes screening. Our data show that 37% of all subjects with new diabetes in the SHS baseline exam and 55.2% of those in the second exam have 2hPG ≥200 but FPG <126. These cases of diabetes cannot be detected if FPG is used alone in a diabetes screening. Therefore, although the small portion of diabetes in the NFG group (4.7% in the baseline and 6.9% in the second exam) may be ignored, those cases of diabetes among IFG participants (∼20% in our data) need further consideration in a diabetes screening. It may be worthwhile for those IFG participants identified by the optimal critical line to take an OGTT. The optimal critical line and time interval between successive diabetes screenings need further study.

    • 2hPG, 2-h postload glucose
    • ADA, American Diabetes Association
    • FPG, fasting plasma glucose
    • 2hPG, IFG, impaired fasting glucose
    • INNSZ, Instituto Nacional de la Nutricion Salvador Zubiran
    • NFG, normal fasting glucose
    • OGTT, oral glucose tolerance test
    • ROC, receiver operating characteristic
    • SHS, Strong Heart Study

    Footnotes

    • Address correspondence and reprint requests to Wenyu Wang, College of Public Health, P.O. Box 26901, University of Oklahoma, HSC, Oklahoma City, OK 73190. E-mail: wenyu-wang{at}ouhsc.edu.

      Received for publication 23 October 2001 and accepted in revised form 17 April 2002.

      This article does not necessarily represent the views of the Indian Health Service.

      A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    • DIABETES CARE
    View Full Text
    PreviousNext
    Back to top
    Diabetes Care: 25 (8)

    In this Issue

    August 2002, 25(8)
    • Table of Contents
    • About the Cover
    • Index by Author
    Sign up to receive current issue alerts
    View Selected Citations (0)
    Print
    Download PDF
    Article Alerts
    Sign In to Email Alerts with your Email Address
    Email Article

    Thank you for your interest in spreading the word about Diabetes Care.

    NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

    Enter multiple addresses on separate lines or separate them with commas.
    Using HbA1c to Improve Efficacy of the American Diabetes Association Fasting Plasma Glucose Criterion in Screening for New Type 2 Diabetes in American Indians
    (Your Name) has forwarded a page to you from Diabetes Care
    (Your Name) thought you would like to see this page from the Diabetes Care web site.
    CAPTCHA
    This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
    Citation Tools
    Using HbA1c to Improve Efficacy of the American Diabetes Association Fasting Plasma Glucose Criterion in Screening for New Type 2 Diabetes in American Indians
    Wenyu Wang, Elisa T. Lee, Richard Fabsitz, Thomas K. Welty, Barbara V. Howard
    Diabetes Care Aug 2002, 25 (8) 1365-1370; DOI: 10.2337/diacare.25.8.1365

    Citation Manager Formats

    • BibTeX
    • Bookends
    • EasyBib
    • EndNote (tagged)
    • EndNote 8 (xml)
    • Medlars
    • Mendeley
    • Papers
    • RefWorks Tagged
    • Ref Manager
    • RIS
    • Zotero
    Add to Selected Citations
    Share

    Using HbA1c to Improve Efficacy of the American Diabetes Association Fasting Plasma Glucose Criterion in Screening for New Type 2 Diabetes in American Indians
    Wenyu Wang, Elisa T. Lee, Richard Fabsitz, Thomas K. Welty, Barbara V. Howard
    Diabetes Care Aug 2002, 25 (8) 1365-1370; DOI: 10.2337/diacare.25.8.1365
    del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
    • Tweet Widget
    • Facebook Like
    • Google Plus One

    Jump to section

    • Article
      • Abstract
      • RESEARCH DESIGN AND METHODS
      • RESULTS
      • CONCLUSIONS
      • CONCLUSIONS
      • APPENDIX
      • Footnotes
      • References
    • Figures & Tables
    • Info & Metrics
    • PDF

    Related Articles

    Cited By...

    More in this TOC Section

    • Suboptimal Use of Cardioprotective Drugs in Newly Treated Elderly Individuals With Type 2 Diabetes
    • Disparities in Diabetes Care Between Smokers and Nonsmokers
    • Changing Patterns of Type 2 Diabetes Incidence Among Pima Indians
    Show more Epidemiology/Health Services/Psychosocial Research

    Similar Articles

    Navigate

    • Current Issue
    • Standards of Care Guidelines
    • Online Ahead of Print
    • Archives
    • Submit
    • Subscribe
    • Email Alerts
    • RSS Feeds

    More Information

    • About the Journal
    • Instructions for Authors
    • Journal Policies
    • Reprints and Permissions
    • Advertising
    • Privacy Policy: ADA Journals
    • Copyright Notice/Public Access Policy
    • Contact Us

    Other ADA Resources

    • Diabetes
    • Clinical Diabetes
    • Diabetes Spectrum
    • Scientific Sessions Abstracts
    • Standards of Medical Care in Diabetes
    • BMJ Open - Diabetes Research & Care
    • Professional Books
    • Diabetes Forecast

     

    • DiabetesJournals.org
    • Diabetes Core Update
    • ADA's DiabetesPro
    • ADA Member Directory
    • Diabetes.org

    © 2021 by the American Diabetes Association. Diabetes Care Print ISSN: 0149-5992, Online ISSN: 1935-5548.