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Hemoglobin A1c can be helpful in predicting progression to diabetes after Whipple procedure.

ABSTRACT: INTRODUCTION: Normoglycemic patients undergoing pancreaticoduodenectomy (Whipple procedure) often inquire whether they will be diabetic postoperatively. There is limited information on this issue. We therefore looked at a more subtle measurement of long-term glycemic control, hemoglobin A1c (HgbA1c), as a prognostic tool in predicting progression to diabetes post Whipple. PATIENTS AND METHODS: A retrospective review over a 6-year period of all patients undergoing Whipple procedures at a single institution was conducted. In all, 27 patients had no prior history of diabetes, complete follow-up, and measured preoperative HgbA1c values. Postoperative diabetes was defined as the need for oral hypoglycemic agents or insulin. These charts were analyzed for progression to diabetes after Whipple. RESULTS: Of the 27 patients, 10 were considered to have postoperative diabetes. The average preoperative HgbA1c value for these patients was 6.3+/-0.66. This was statistically different from the 17 patients without postoperative diabetes (average HgbA1c 5.2+/-0.39, p<0.001). The positive predictive value, negative predictive value, sensitivity, and specificity were 82%, 94%, 90%, and 88%, respectively. CONCLUSION: This study demonstrates that progression to diabetes is very unlikely after Whipple operation if the preoperative HgbA1c value is in the normal range. The apparent utility of HgbA1c in predicting postoperative diabetes in this small study suggests that this laboratory test may be very helpful in counseling patients for Whipple operation.

SUBMITTER: Hamilton L

PROVIDER: S-EPMC2020780 | biostudies-other | 2007

REPOSITORIES: biostudies-other

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Using hemoglobin A1C as a predicting model for time interval from pre-diabetes progressing to diabetes.

Project description:ObjectiveThe early identification of subjects at high risk for diabetes is essential, thus, random rather than fasting plasma glucose is more useful. We aim to evaluate the time interval between pre-diabetes to diabetes with anti-diabetic drugs by using HbA1C as a diagnostic tool, and predicting it using a mathematic model.MethodsWe used the Taipei Medical University Affiliated Hospital Patient Profile Database (AHPPD) from January-2007 to June-2011. The patients who progressed and were prescribed anti-diabetic drugs were selected from AHPPD. The mathematical model used to predict the time interval of HbA1C value ranged from 5.7% to 6.5% for diabetes progression.ResultsWe predicted an average overall time interval for all participants in between 5.7% to 6.5% during a total of 907 days (standard error, 103 days). For each group found among 5.7% to 6.5% we determined 1169.3 days for the low risk group (i.e. 3.2 years), 1080.5 days (i.e. 2.96 years) for the increased risk group and 729.4 days (i.e. 1.99 years) for the diabetes group. This indicates the patients will take an average of 2.49 years to reach 6.5%.ConclusionThis prediction model is very useful to help prioritize the diagnosis at an early stage for targeting individuals with risk of diabetes. Using patients' HbA1C before anti-diabetes drugs are used we predicted the time interval from pre-diabetes progression to diabetes is 2.49 years without any influence of age and gender. Additional studies are needed to support this model for a long term prediction.

| S-EPMC4122428 | biostudies-literature

Hemoglobin a1c and the progression of coronary artery calcification among adults without diabetes.

Project description:ObjectiveHigher levels of hemoglobin A1c (HbA1c) are associated with increased cardiovascular disease risk among individuals without diabetes and may also be positively associated with coronary artery calcification (CAC). This study investigated the association of HbA1c with CAC progression in the Coronary Artery Risk Development in Young Adults study.Research design and methodsWe included 2,076 participants with HbA1c and noncontrast computed tomography (CT) assessed at baseline (2005-2006), and CT repeated 5 years later (2010-2011). CAC progression was defined as 1) incident CAC (increase >0 Agatston units among those with no CAC at baseline), 2) any CAC progression (increase >10 Agatston units between examinations), and 3) advanced CAC progression (increase >100 Agatston units between examinations).ResultsDuring the 5-year follow-up period, 12.9% of participants without baseline CAC developed incident CAC; among all participants, 18.2% had any CAC progression and 5.4% had advanced CAC progression. Higher HbA1c was associated with incident CAC (risk ratio [RR] = 1.45; 95% CI 1.02, 2.06), any CAC progression (RR = 1.51; 95% CI 1.16, 1.96), and advanced CAC progression (RR = 2.42; 95% CI 1.47, 3.99) after adjustment for sociodemographic factors. Additional adjustment for cardiovascular risk factors attenuated the associations of HbA1c with incident CAC (RR = 1.05; 95% CI 0.74, 1.49) and any CAC progression (RR = 1.13; 95% CI 0.87, 1.47). In contrast, the association of HbA1c with advanced CAC progression persisted in multivariable adjusted models (RR = 1.78; 95% CI 1.08, 2.95).ConclusionsHigher HbA1c was independently associated with advanced CAC progression among individuals without diabetes, while the associations with incident CAC and any CAC progression were accounted for by other established cardiovascular risk factors.

| S-EPMC4274774 | biostudies-literature

Type 2 Diabetes Prevention: Implications of Hemoglobin A1c Genetics.

Project description:Hemoglobin A1c (HbA1c) is a biomarker used for population-level screening of type 2 diabetes (T2D) and risk stratification. Large-scale, genome-wide association studies have identified multiple genomic loci influencing HbA1c. We discuss the challenges of classifying these genomic loci as influencing HbA1c through glycemic or nonglycemic pathways, based on their probable biology and pleiotropic associations with erythrocyte traits. We show that putative nonglycemic genetic variants have a measurable, albeit small, impact on the classification of T2D status by HbA1c in white and Asian populations. Accounting for their effect on HbA1c may be relevant when screening populations with higher frequencies of nonglycemic HbA1c-altering alleles. As carriers of such HbA1c-altering alleles have HbA1c levels that may not accurately reflect overall glycemia, we describe how accounting for genotype may improve the performance of HbA1c in T2D prediction models and risk stratification, allowing for lifestyle intervention strategies to be directed towards those who are truly at elevated risk for developing T2D. In a Mendelian randomization framework, genetic variants can be used as instrumental variables to estimate causal relationships between HbA1c and T2D-related complications. This approach may help to support or refute HbA1c as an appropriate biomarker for long-term health outcomes in the general population.

| S-EPMC5275759 | biostudies-literature

Is Hemoglobin A1c the Right Outcome for Studies of Diabetes?

Project description: Not available

| S-EPMC5350060 | biostudies-literature

Contributions of Glucose and Hemoglobin A1c Measurements in Diabetes Screening.

Project description:ObjectivesGiven the long-term consequences of untreated diabetes, patients benefit from timely diagnoses. Payer policies often recognize glucose but not hemoglobin A1c (HbA1c) for diabetes screening. This study evaluates the different information that glucose and HbA1c provide for diabetes screening.MethodsWe conducted a retrospective review of national clinical laboratory testing during 2020 when glucose and HbA1c were ordered for routine diabetes screening, excluding patients with known diabetes, out-of-range glucose, or metabolic syndrome.ResultsOf 15.47 million glucose and HbA1c tests ordered simultaneously, 672,467 (4.35%) met screening inclusion criteria; 116,585 (17.3%) were excluded because of diabetes-related conditions or the specimen was nonfasting, leaving 555,882 result pairs. More than 1 in 4 patients 60 years of age or older with glucose within range had an elevated HbA1c level. HbA1c claims were denied more often for Medicare beneficiaries (38,918/65,273 [59.6%]) than for other health plans combined (23,234/291,764 [8.0%]).ConclusionsAlthough many health plans do not cover HbA1c testing for diabetes screening, more than 1 in 4 glucose screening patients 60 years of age or older with an in-range glucose result had a concurrent elevated HbA1c result. Guideline developers and health plans should explicitly recognize that glucose and HbA1c provide complementary information and together offer improved clinical utility for diabetes screening.

| S-EPMC8742979 | biostudies-literature

Glycosylated Hemoglobin A1c Improves the Performance of the Nomogram for Predicting the 5-Year Incidence of Type 2 Diabetes.

Project description:AimTo develop and validate a model, which combines traditional risk factors and glycosylated hemoglobin A1c (HbA1c) for predicting the risk of type 2 diabetes (T2DM).Materials and methodsThis is a historical cohort study from a collected database, which included 8419 males and 7034 females without diabetes at baseline with a median follow-up of 5.8-years and 5.1-years, respectively. Multivariate cox regression analysis was used to select significant prognostic factors of T2DM. Two nomograms were constructed to predict the 5-year incidence of T2DM based on traditional risk factors (Model 1) and traditional risk factors plus HbA1c (Model 2). C-index, calibration curve, and time-dependent receiver-operating characteristic (ROC) curve were conducted in the training sets and validation sets.ResultsIn males, the C-index was 0.824 (95% CI: 0.795-0.853) in Model 1 and 0.867 (95% CI: 0.840-0.894) in Model 2; in females, the C-index was 0.830 (95% CI: 0.770-0.890) in Model 1 and 0.856 (95% CI: 0.795-0.917) in Model 2. The areas under curve (AUC) in Model 2 for prediction of T2DM development were higher than in Model 1 at each time point. The calibration curves showed excellent agreement between the predicted possibility and the actual observation in both models. The results of validation sets were similar to the results of training sets.ConclusionThe proposed nomogram can be used to accurately predict the risk of T2DM. Compared with the traditional nomogram, HbA1c can improve the performance of nomograms for predicting the 5-year incidence of T2DM.

| S-EPMC7247728 | biostudies-literature

Association between hemoglobin within the normal range and hemoglobin A1c among Chinese non-diabetes adults.

Project description:BackgroundHemoglobin A1c (HbA1c) is the product of a non-enzymatic chemical reaction between hemoglobin (Hb) and glucose. However, the association between Hb and HbA1c remains to be fully elucidated in view of the controversial findings reported to date. Therefore, our aim in this study was to evaluate the association between Hb levels within the normal range and HbA1c levels among Chinese non-diabetes adults using cross-sectional data from the China Health and Nutrition Survey 2009.MethodsOur analysis was based on the data of 1659 non-diabete adults 20-49 years of age. Multivariable linear models were applied to examine the association between Hb and HbA1c levels. Subgroup analyses stratified by age and sex were also performed.ResultsThe association between Hb and HbA1c levels was positive in the unadjusted model (β =0.020, 95% CI: 0.008, 0.032). However, this association did not remain significant when the regression model was minimally adjusted for age and sex (β =0.006, 95% CI: - 0.014, 0.024); this association became negative when the model was further adjusted for covariates whose effect estimates of HbA1c levels more than 10% (β = - 0.042, 95% CI: - 0.064, - 0.020). The association remained negative on subgroup analyses stratified by age (20-34 years: β = - 0.052, 95% CI: - 0.091, - 0.013; 35-49 years: β = - 0.041, 95% CI: - 0.068, - 0.014) and sex (men: β = - 0.042, 95% CI: - 0.074, - 0.010; women: β = - 0.042, 95% CI: - 0.073, - 0.012) when controlling for covariates.ConclusionsOur findings revealed that Hb levels within the normal range were negatively associated with HbA1c levels among Chinese non-diabetes adults. Confounding factors, such as red blood cell counts can affect the association between Hb and HbA1c levels.

| S-EPMC7916310 | biostudies-literature

Hemoglobin A1c Trajectory in Pediatric Patients with Newly Diagnosed Type 1 Diabetes.

Project description:Despite advances in diabetes technology and treatment, a majority of children and adolescents with type 1 diabetes (T1D) fail to meet hemoglobin A1c (HbA1c) targets. Among high-income nations, the United States has one of the highest mean HbA1c values. We tracked the HbA1c values of 261 patients diagnosed with T1D in our practice over a 2.5-year period to identify inflection points in the HbA1c trajectory. The HbA1c declined until 5 months postdiagnosis. There was a rise in the HbA1c between the fifth and sixth month postdiagnosis. The HbA1c continued to steadily rise and by 18 months postdiagnosis, the mean HbA1c was 8.2%, which is also our clinic mean. Understanding the HbA1c trajectory early in the course of diabetes has helped to identify opportunities for intensification of diabetes management to flatten the trajectory of HbA1c and improve clinical outcomes.

| S-EPMC7001422 | biostudies-literature

Prediction of Type 2 Diabetes by Hemoglobin A1c in Two Community-Based Cohorts.

Project description:OBJECTIVE:Hemoglobin A1c (HbA1c) can be used to assess type 2 diabetes (T2D) risk. We asked whether HbA1c was associated with T2D risk in four scenarios of clinical information availability: 1) HbA1c alone, 2) fasting laboratory tests, 3) clinic data, and 4) fasting laboratory tests and clinic data. RESEARCH DESIGN AND METHODS:We studied a prospective cohort of white (N = 11,244) and black (N = 2,294) middle-aged participants without diabetes in the Framingham Heart Study and Atherosclerosis Risk in Communities study. Association of HbA1c with incident T2D (defined by medication use or fasting glucose [FG] ?126 mg/dL) was evaluated in regression models adjusted for 1) age and sex (demographics); 2) demographics, FG, HDL, and triglycerides; 3) demographics, BMI, blood pressure, and T2D family history; or 4) all preceding covariates. We combined results from cohort and race analyses by random-effects meta-analyses. Subsidiary analyses tested the association of HbA1c with developing T2D within 8 years or only after 8 years. RESULTS:Over 20 years, 3,315 individuals developed T2D. With adjustment for demographics, the odds of T2D increased fourfold for each percentage-unit increase in HbA1c. The odds ratio (OR) was 4.00 (95% CI 3.14, 5.10) for blacks and 4.73 (3.10, 7.21) for whites, resulting in a combined OR of 4.50 (3.35, 6.03). After adjustment for fasting laboratory tests and clinic data, the combined OR was 2.68 (2.15, 3.34) over 20 years, 5.79 (2.51, 13.36) within 8 years, and 2.23 (1.94, 2.57) after 8 years. CONCLUSIONS:HbA1c predicts T2D in different common scenarios and is useful for identifying individuals with elevated T2D risk in both the short- and long-term.

| S-EPMC5741154 | biostudies-literature

Consistency of Hemoglobin A1c Testing and Cardiovascular Outcomes in Medicare Patients With Diabetes.

Project description:BackgroundAnnual hemoglobin A1c testing is recommended for patients with diabetes mellitus. However, it is unknown how consistently patients with diabetes mellitus receive hemoglobin A1c testing over time, or whether testing consistency is associated with adverse cardiovascular outcomes.Methods and resultsWe identified 1 574 415 Medicare patients (2002-2012) with diabetes mellitus over the age of 65. We followed each patient for a minimum of 3 years to determine their consistency in hemoglobin A1C testing, using 3 categories: low (testing in 0 or 1 of 3 years), medium (testing in 2 of 3 years), and high (testing in all 3 years). In unweighted and inverse propensity-weighted cohorts, we examined associations between testing consistency and major adverse cardiovascular events, defined as death, myocardial infarction, stroke, amputation, or the need for leg revascularization. Overall, 70.2% of patients received high-consistency testing, 17.6% of patients received medium-consistency testing, and 12.2% of patients received low-consistency testing. When compared to high-consistency testing, low-consistency testing was associated with a higher risk of adverse cardiovascular events or death in unweighted analyses (hazard ratio [HR]=1.21; 95% CI, 1.20-1.23; P<0.001), inverse propensity-weighted analyses (HR=1.16; 95% CI, 1.15-1.17; P<0.001), and weighted analyses limited to patients who had at least 4 physician visits annually (HR=1.15; 95% CI, 1.15-1.16; P<0.001). Less-consistent testing was associated with worse results for each cardiovascular outcome and in analyses using all years as the exposure.ConclusionsConsistent annual hemoglobin A1c testing is associated with fewer adverse cardiovascular outcomes in this observational cohort of Medicare patients of diabetes mellitus.

| S-EPMC5015285 | biostudies-literature

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