Dataset Information

HbA1c alone is a poor indicator of cardiometabolic risk in middle-aged subjects with pre-diabetes but is suitable for type 2 diabetes diagnosis: a cross-sectional study.

ABSTRACT:

Objectives

Glycated haemoglobin A1c (HbA1c) measurement is recommended as an alternative to fasting plasma glucose (FPG) for the diagnosis of pre-diabetes and type 2 diabetes. However, evidence suggests discordance between HbA1c and FPG. In this study we examine a range of metabolic risk features, pro-inflammatory cytokines, acute-phase response proteins, coagulation factors and white blood cell counts to determine which assay more accurately identifies individuals at increased cardiometabolic risk.

Materials and methods

This was a cross-sectional study involving a random sample of 2,047 men and women aged 46-73 years. Binary and multinomial logistic regression were employed to examine risk feature associations with pre-diabetes [either HbA1c levels 5.7-6.4% (39-46 mmol/mol) or impaired FPG levels 5.6-6.9 mmol/l] and type 2 diabetes [either HbA1c levels >6.5% (>48 mmol/mol) or FPG levels >7.0 mmol/l]. Receiver operating characteristic curve analysis was used to evaluate the ability of HbA1c to discriminate pre-diabetes and diabetes defined by FPG.

Results

Stronger associations with diabetes-related phenotypes were observed in pre-diabetic subjects diagnosed by FPG compared to those detected by HbA1c. Individuals with type 2 diabetes exhibited cardiometabolic profiles that were broadly similar according to diagnosis by either assay. Pre-diabetic participants classified by both assays displayed a more pro-inflammatory, pro-atherogenic, hypertensive and insulin resistant profile. Odds ratios of having three or more metabolic syndrome features were also noticeably increased (OR: 4.0, 95% CI: 2.8-5.8) when compared to subjects diagnosed by either HbA1c (OR: 1.4, 95% CI: 1.2-1.8) or FPG (OR: 3.0, 95% CI: 1.7-5.1) separately.

Conclusions

In middle-aged Caucasian-Europeans, HbA1c alone is a poor indicator of cardiometabolic risk but is suitable for diagnosing diabetes. Combined use of HbA1c and FPG may be of additional benefit for detecting individuals at highest odds of type 2 diabetes development.

SUBMITTER: Millar SR

PROVIDER: S-EPMC4534196 | biostudies-literature | 2015

REPOSITORIES: biostudies-literature

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Publications

HbA1c alone is a poor indicator of cardiometabolic risk in middle-aged subjects with pre-diabetes but is suitable for type 2 diabetes diagnosis: a cross-sectional study.

Millar Seán R SR Perry Ivan J IJ Phillips Catherine M CM

PloS one 20150812 8

<h4>Objectives</h4>Glycated haemoglobin A1c (HbA1c) measurement is recommended as an alternative to fasting plasma glucose (FPG) for the diagnosis of pre-diabetes and type 2 diabetes. However, evidence suggests discordance between HbA1c and FPG. In this study we examine a range of metabolic risk features, pro-inflammatory cytokines, acute-phase response proteins, coagulation factors and white blood cell counts to determine which assay more accurately identifies individuals at increased cardiomet ...[more]

PMID: 26266799

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Project description:OBJECTIVES:Despite recommendations that central obesity assessment should be employed as a marker of cardiometabolic health, no consensus exists regarding measurement protocol. This study examined a range of anthropometric variables and their relationships with cardiometabolic features and type 2 diabetes in order to ascertain whether measurement site influences discriminatory accuracy. In particular, we compared waist circumference (WC) measured at two sites: (1) immediately below the lowest rib (WC rib) and (2) between the lowest rib and iliac crest (WC midway), which has been recommended by the World Health Organisation and International Diabetes Federation. MATERIALS AND METHODS:This was a cross-sectional study involving a random sample of 2,002 men and women aged 46-73 years. Metabolic profiles and WC, hip circumference, pelvic width and body mass index (BMI) were determined. Correlation, logistic regression and area under the receiver operating characteristic curve analyses were used to evaluate obesity measurement relationships with metabolic risk phenotypes and type 2 diabetes. RESULTS:WC rib measures displayed the strongest associations with non-optimal lipid and lipoprotein levels, high blood pressure, insulin resistance, impaired fasting glucose, a clustering of metabolic risk features and type 2 diabetes, in both genders. Rib-derived indices improved discrimination of type 2 diabetes by 3-7% compared to BMI and 2-6% compared to WC midway (in men) and 5-7% compared to BMI and 4-6% compared to WC midway (in women). A prediction model including BMI and central obesity displayed a significantly higher area under the curve for WC rib (0.78, P=0.003), Rib/height ratio (0.80, P<0.001), Rib/pelvis ratio (0.79, P<0.001), but not for WC midway (0.75, P=0.127), when compared to one with BMI alone (0.74). CONCLUSIONS:WC rib is easier to assess and our data suggest that it is a better method for determining obesity-related cardiometabolic risk than WC midway. The clinical utility of rib-derived indices, or alternative WC measurements, deserves further investigation.

Project description:Background/objectivesLittle is known about relation of overall breakfast quality with cardiometabolic risk factors. Therefore, this study aimed to explore sex-specific associations between breakfast quality and cardiometabolic risk profiles in a sample of an upper middle-aged German population.Subjects/methodsCardiometabolic profiles of 339 men and 329 women were cross-sectionally assessed using an overall biomarker score (BScore), glycated hemoglobin (HbA1c), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), blood pressure, body mass index (BMI) and waist circumference (WC). Overall breakfast quality was assessed by using (i) an a-priori defined breakfast quality score (BQS) and (ii) data-driven breakfast patterns based on principal component analysis (PCA). Multiple linear regression models for association of breakfast quality with all outcomes were adjusted for all potential confounders including overall diet quality.ResultsAfter adjustment for all potential confounders the BQS was inversely associated with the BScore (regression beta with 95% Confidence Interval: -0.29 (052-0.06)) and HbA1c (-0.12 (-0.21, -0.04)) in men; whereas no such associations were observed in women. Four breakfast (B) patterns were identified: B-processed-food pattern, B-cereal pattern, B-high fat pattern and B-dairy & cereal pattern. The B-processed-food pattern was positively associated with HbA1c (0.09(0.01, 0.18)), BMI (0.16 (0.06, 0.26)), and WC (0.17 (0.8, 0.26)) in men, and BMI (0.13 (0.1, 0.25)) and WC (0.11(0.01.0.22)) in women. The B-cereal pattern was inversely associated with BScore (-0.23 (-0.45, -0.01)) and BMI (-0.11 (-0.20, -0.01)) in men and WC(-0.16 (-0.27, -0.05)) in women. The B-dairy & cereal pattern was also inversely associated with BScore (-0.26 (-0.48, -0.04)) in men but not in women.ConclusionsThe overall breakfast quality was cross-sectionally associated with a healthier cardiometabolic profile, especially in upper-middle age men, independent of overall dietary quality. Such analyses should be supplemented by studies investigating the circadian sequence of food intake and metabolic consequences including hard disease endpoints.

Dataset Information

HbA1c alone is a poor indicator of cardiometabolic risk in middle-aged subjects with pre-diabetes but is suitable for type 2 diabetes diagnosis: a cross-sectional study.

Objectives

Materials and methods

Results

Conclusions

Publications

HbA1c alone is a poor indicator of cardiometabolic risk in middle-aged subjects with pre-diabetes but is suitable for type 2 diabetes diagnosis: a cross-sectional study.

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