Ann Lab Med.  2020 Nov;40(6):457-465. 10.3343/alm.2020.40.6.457.

Exploration and Validation of the Performance of Hemoglobin A1c in Detecting Diabetes in CommunityDwellers With Hypertension

• Qiu S
• Du Z
• Li W
• Chen J
• Wu H
• Liu J
• Cai M
• Wang B
• Guo H
• Sun Z

• KMID: 2507791
• DOI: http://doi.org/10.3343/alm.2020.40.6.457

Abstract

Background
Diabetes can complicate hypertension management by increasing the risk of cardiovascular disease (CVD) and all-cause mortality. Studies targeting diabetes detection in hypertensive individuals demonstrating an increased risk of diabetes are lacking. We aimed to assess the performance of hemoglobin A_1c (HbA_1c) and its cut-off point in detecting diabetes in the abovementioned population.
Methods
Data from 4,096 community-dwellers with hypertension but without known diabetes were obtained from the Study on Evaluation of iNnovated Screening tools and determInation of optimal diagnostic cut-off points for type 2 diaBetes in Chinese muLti-Ethnic (SENSIBLE) study; these data were randomly split into exploration (70% of the sample) and internal validation (the remaining 30%) datasets. The optimal HbA_1c cut-off point was derived from the exploration dataset and externally validated using another dataset from 2,431 hypertensive individuals. The oral glucose tolerance test was considered the goldstandard for confirming diabetes.
Results
The areas under the ROC curves for HbA_1c to detect diabetes were 0.842, 0.832, and 0.829 for the exploration, internal validation, and external validation datasets, respectively. An optimal HbA_1c cut-off point of 5.8% (40 mmol/mol) yielded a sensitivity of 76.2% and a specificity of 74.5%. Individuals who were not diagnosed as having diabetes by HbA_1c at 5.8% (40 mmol/mol) had a lower 10-year CVD risk score than those diagnosed as having diabetes (P = 0.01). HbA_1c ≤ 5.1% (32 mmol/mol) and ≥ 6.4% (46 mmol/mol) could indicate the absence and presence of diabetes, respectively.
Conclusions
HbA_1c could detect diabetes effectively in community-dwellers with hypertension.

Keyword

Hemoglobin A_1c; Diabetes; Hypertension; Detection; Cut-off; Community-dwellers; Cardiovascular disease

Figure

• 

  Fig. 1 Participant selection process for (A) the SENSIBLE study and (B) the SENSIBLE-Addition study. *indicates missing information for age, BMI, WC, smoking, glycemic biomarkers, and lipid profiles; †Outliers indicate data >99th percentile or <1st percentile of the dataset; ‡Data for these individuals were randomly split into the exploration dataset (70% of the sample) and the internal validation dataset (the remaining 30%). Abbreviations: SENSIBLE, Study on Evaluation of iNnovated Screening tools and determInation of optimal diagnostic cut-off points for type 2 diaBetes in Chinese muLti-Ethnic; BMI, body mass index; WC, waist circumference.

• 

  Fig. 2 ROC curves for hemoglobin A1c in the different study cohorts. (A) exploration dataset. (B) internal validation dataset. (C) external validation dataset. Abbreviations: AUROC, area under the ROC curve; CI, confidence interval.

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