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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
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    • Figure 1—
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      Figure 1—

      The ROC curves based on the logistic regression models on FPG, HbA1c, and HbA1c and FPG. The areas under the respective ROC curves are denoted as the area for FPG, the area for HbA1c, and the area for HbA1c and FPG. They are calculated as 0.640343, 0.7053313, and 0.7237567, respectively. The results from a comparison of these areas are as follows: P = 0.153 for the area for FPG vs. the area for HbA1c; P = 0.0008 for the area for FPG vs. the area for HbA1c and FPG; P = 0.463 for the area for HbA1c vs. the area for HbA1c and FPG.

    • Figure 2—
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      Figure 2—

      The optimal critical lines for R = P/(1 − P) based on the data from the SHS baseline and second exams. Those IFG participants whose FPG and HbA1c are above or on the line are referred to take an OGTT for possible diabetes (2hPG ≥200 mg/dl).

    Tables

    • Figures
    • Table 1—

      FPG by 2hPG levels: the SHS

      2hPG (mg/dl)FPG (mg/dl)
      <110110–126>126Total
      Baseline exam
       <2001,4894271172,033
       ≥20074102180356
       Total1,5635292972,389
      Second exam
       <2001,058289571,404
       ≥200788676240
       Total1,1363751331,644
    • Table 2—

      The optimal critical line for different cost-to-benefit ratio R

      RFPG at the intercept of OCL and HbA1c = 0 (mg/dl)HbA1c at the intercept of OCL and FPG = 110 (%)HbA1c at the intercept of OCL and FPG = 126 (%)Z*k*Specificity (%)Sensitivity (%)
      SHS baseline examination (OCL: 0.89 × HbA1c + 0.11 × FPG = Z*)
       P /(1 − P)162.936.544.5617.9240.22276.8158.82
       0.05153.265.353.3716.8610.09018.0397.06
       0.10154.225.473.4916.9660.09923.8995.10
       0.15157.745.903.9217.3530.13944.9683.33
       0.20160.506.244.2617.6570.18061.8371.57
       0.25162.936.544.5617.9240.22276.8158.82
       0.30164.316.714.7418.0760.25081.9752.94
       0.35164.316.714.7418.0760.25081.9752.94
       0.40164.316.714.7418.0760.25081.9752.94
       0.45164.316.714.7418.0760.25081.9752.94
       0.50169.167.315.3418.6100.36295.3226.47
       1.00170.787.515.5418.7880.40497.4219.61
      SHS second examination (OCL: 0.106 × HbA1c + 0.078 × FPG = Z*)
       P /(1 − P)120.317.61−4.209.4330.18936.3383.72
       0.05117.315.40−6.419.1970.1559.3498.84
       0.10117.315.40−6.419.1970.1559.3498.84
       0.15117.315.40−6.419.1970.1559.3498.84
       0.20120.317.61−4.209.4330.18936.3383.72
       0.25120.317.61−4.209.4330.18936.3383.72
       0.30120.317.61−4.209.4330.18936.3383.72
       0.35127.3112.780.979.9810.28783.7430.23
       0.40127.3112.780.979.9810.28783.7430.23
       0.45127.3112.780.979.9810.28783.7430.23
       0.50128.2613.481.6710.0560.30387.5424.42
       1.00132.8016.845.0210.4120.38298.963.49
      • R = the costs-to-benefit ratio; P = the prevalence of diabetes in IFG participants, which is estimated as 0.193 and 0.229 based on the data from the baseline and second exam, respectively; k* = the optimal cutoff point; Z* = log[k* /(1 − k*)]− a, where a is the estimated intercept in the fitted logistic regression model on FPG and HbA1c, and a = −19.176 and −10.891 based on the data from the baseline and second exam, respectively. All variables are defined in research design and methods (statistical analysis). OCL, optimal critical line.

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    Diabetes Care: 25 (8)

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    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

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    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
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